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Affidavit of Guardianship

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Republic of the Philippines )

City of ______ ) S.S.


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

AFFIDAVIT OF GUARDIANSHIP

I, ERMELINDA J. YAGONG, of legal age, single/married/widow,


Filipino citizen, and presently residing at Brgy. Sto. Niño, Basilisa, Dinagat
Islands, after having been duly sworn to in accordance with law, do hereby
depose and say:

1. That I am the GRANDMOTHER and guardian of the following minor/s who has
/ have an interest in applying for DOST-SEI JLSS Examination;

Full Name of Minor/s Date of Birth Age


JAYTHER V. YAGONG DEC. 6, 1998 20 YRS. OLD

2. That the above mentioned minor/s is/are under my care and custody;

3. That I am competent to receive in behalf of the said minor/s any amount/s due
him/them; and

4. That 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. That 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


_______ 2019 at ______________, Philippines.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______


2019 in _________, Philippines, affiant exhibiting to me his/her competent evidence
of identity by way of _______________ issued at ___________
on ________________.

Doc No. : _____


Page No.: ______
Book No.: ______
Series No.:______ Notary Public

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