REPUBLIC OF THE PHILIPPINES )
Done in the ________________) S.S.
AFFIDAVIT OF GUARDIANSHIP
I, _____________________, of legal age, single/married/widow/widower, with residence at
______________________________, under oath in accordance with the law, hereby declare that:
1. I am the
□ Grandparent
□ Older Brother
□ Older Sister
□ Actual custodian, (state relationship with the athlete)
of ________________________________, an athlete competing in the _________ Palarong Pambansa.
2. The above-named athlete is under my care and custody for _________ years due to the fact that his/her parents
are
□ Deceased
□ Absent
□ Incapacitated
□ Civilly interdicted
□ Others _________________________
3. I am of sound mind, of good moral character, responsible, and not otherwise disqualified by law to serve as
guardian over the person of the above-mentioned minor;
I am executing this affidavit to attest to the truthfulness of the foregoing statements and for whatever purposes it may
serve in the _________ Palarong Pambansa.
IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of __________________ 20____ in
_____________________, Philippines.
GUARDIAN’S NAME
Affiant-Declarant
SUBSCRIBED AND SWORN to before me this ___________of __________ 20____ in ________________, affiant-
declarant personally appeared and presented to me his/her (government issued id) bearing the numbers ________________
issued on _______________ in _______________________. After personally examining the affiant, I am convinced that she read
and understood the content of this affidavit and that this is his/her free and voluntary act.
Doc. No. ;
Page No.;
Book No. ‘
Series of 2017 ;
Page 1 of 1