PAO FORM No.
2010-1-A
Republic of the Philippines
Province of S.s.
City/Municipality of
AFFIDAVIT OF INDIGENCY
I, of legal age, single/married to
and residing at
and having been duly sworn in
accordance with law, depose and say:
1. That I desire to avail of the free legal service of the Public Attorney’s Office.
2. That my monthly net salary/income is P .
3. That I am executing this affidavit to entitle me to the desired legal services.
IN WITNESS WHEREOF, I have hereunto affixed my signature this day of
, 20 , in the City/Municipality of , Province of
.
Signature of Affiant
SUBSCRIBED AND SWORN to before me this day of , 20 at
, and I have read and translated the foregoing Affidavit in a
dialect known and understood by him/her.
ATTY.
Public Attorney II
(Pursuant to R.A. 9406)