Republic of the Philippines )

Makati City ) S.S.

x---------------------------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, _________________, of legal age, married, Filipino citizen, and

presently residing at ______________, after having been duly sworn to in
accordance with law, do hereby depose and state that:

1. I am the ______________ and guardian of the following minor

who is being petitioned to migrate in ______________ under
______________;

Full Name of Minor Date of Birth Age

2. The above mentioned minor is under my care and custody;

3. I am the mother of ______________ who is solely supporting his

son/daughter since ______________; and

4. I am not an imbecile, insane, a vagrant or a vicious person or

a habitual drunkard or a habitual criminal, and have not
abandoned, neglected or refused to support said minor/s or caused
him/them to commit offenses against the law.

5. I am executing this affidavit to attest to the truth of all the

foregoing statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of _______ 2017 at ______________, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________

at _________________ affiant exhibiting to me his ___________________
valid until ___________________.

Doc. No. ____; NOTARY PUBLIC

Page No. ____;
Book No. ____;
Series of 2017.