REPUBLIC OF THE PHILIPPINES)

CITY OF ORMOC . . . . . . . . . . . . . ) S.S

AFFIDAVIT OF INDIGENCY

I, LOLITA ESTOLONIO, Filipino, of legal age, married and residing at Sitio

Ipil, Brgy. Curva, Ormoc City after having been duly sworn in accordance with law,
depose and state that:

1. I am the petitioner in the above-entitled petition;

2. I filled up the foregoing petition with the assistance of the Clerk of Court;

3. Pursuant to Section 21, Rule 3, 1997 Rules of Civil Procedure, I am

attesting to the fact that I am not in a financial position to pay the entire
docket and other lawful fees, as I do not have money or property
sufficient and available for food, shelter and basic necessities for myself
and my children.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I hereby set my hand this _____ day of

______________________ at Ormoc City, Philippines.

LOLITA ESTOLONIO
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of

______________________ at Ormoc City, Philippines.