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Affidavit of Family

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600 views3 pages

Affidavit of Family

Uploaded by

oopsyyt88
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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AFFIDAVIT OF FAMILY’S FINANCIAL CAPACITY

I, (Name of Parent/Guardian) parent/guardian of


with Learner’s Reference Number (LRN)
of legal age, and resident of after having
been duly swom to in accordance with law, do hereby depose and state the following facts to support the
declarations made in the application for the DepEd Senior High School Voucher Program of
_______________________________ :

I. STUDENT APPLICTAION’S FATHER

FULLNAME
_ Single/Solo Parent
_ Maried
Civil Statues _ Maried, separated
_ Widower
_ Deceased
_ Unknown whereabouts
_ Employment
_ Name of Employer
_ Informal Employment
(Tricycle/Jeepney/Pedicab driver, manicurist, barber, etc)
Source of Income Please specify:
_ Micro/Small business (Sari-sari store, direct selling, etc.)
Please specify:
_ None
Gross Monthly Income
Signature

II. STUDENT APPLICATION’S MOTHER

FULL NAME
_ Single/Solo Parent
_ Maried
Civil Statues _ Maried, separated
_ Widower
_ Deceased
_ Unknown whereabouts
_ Employment
_ Name of Employer
_ Informal Employment
(Tricycle/Jeepney/Pedicab driver, manicurist, barber, etc)
Source of Income Please specify:
_ Micro/Small business (Sari-sari store, direct selling, etc.)
Please specify:
_ None
Gross Monthly Income
Signature

III. STUDENT APPLICANT’S GUARDIAN (LEAVE BLANK IF NOT APPLICABLE)

FULL NAME
_ Single/Solo Parent
_ Maried
Civil Statues _ Maried, separated
_ Widower
_ Deceased
_ Unknown whereabouts
_ Employment
_ Name of Employer
_ Informal Employment
(Tricycle/Jeepney/Pedicab driver, manicurist, barber, etc)
Source of Income Please specify:
_ Micro/Small business (Sari-sari store, direct selling, etc.)
Please specify:
_ None
Gross Monthly Income
Signature

I hereby confirm that I am aware that any wilful, unlawful, and untruthful statement or falsehood upon
material mattes stated in this affidavit and/or required by this vouchers application, as well as other
violations of Guidelines on Eligibility and Application for the Senior High School Voucher Program in
SY 20 -20 issued by DepEd, will disqualify/exclude the applicant and may bar the learner from other
Government Assistance and Subsides (GAS) program by DepEd, without prejudice to applicable
administrative and criminal remedies that may be pursued against me and /or all propoer parties.
I am executing this affidavit to attest to the truth of the forgoing facts and statements.

In WITHNESS WHEREOF, I have hereunto affixed my signature this __ day of ______, 2024 at
____________________, Philippines.

__________________
Affiant
SUSBCRIBED AND SWORN to before me this ___ day of_____, 2024 at ____________________,
Philippines. I hereby certify that I have personally examined the above named affiant, who confirmed to
me that he/she has voluntarily executed the above affidavit and understood the content thereof.

Doc. No.____
Page No.____
Book No. ____
Series of_____

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