REPUBLIC OF THE PHILIPPINES)
Candelaria, Quezon Province )S.S.
AFFIDAVIT OF LOW-INCOME
I, _________________________, Filipino, of legal age, married and presently
residing at _______________________________________________________,
Philippines, after being sworn to in accordance with law, hereby depose and
state THAT:
1. At present, I am a mother who is also a breadwinner and
the only person who is financially supporting my family.
2. I have an estimated monthly income of TEN THOUSAND
PESOS (PhP 10,000.00), more or less, which I usually
earned from working as a Cashier in a Gasoline Station.
3. The said amount which I regularly earned is the sole source
of our family’s income.
4. As such I am a low-income earner. My annual income as
the head of the family is so meager and only enough to
cover our family’s daily needs;
5. In view of the foregoing, I am executing this AFFIDAVIT OF
LOW INCOME:
a) To attest the truthfulness of the foregoing
statements;
b) In support of my APPLICATION FOR FINANCIAL
ASSISTANCE OF ____________________________;
and
c) For whatever legal purpose/s it may serve.
FURTHER AFFIANT SAYETH NAUGHT.
___________________________
Affiant
SUBSCRIBED AND SWORN to me before this ____ day of _________ 2024 at
Candelaria, Quezon, Affiant _______________________________ exhibited to me her
Philippine Passport with No. _______________________ issued by DFA _______________
on ________________ and valid until ________________.
WITNESS MY HAND AND SEAL on the date and place first above written.
Doc. No. ____;
Page No. ____;
Book No.____;
Series of 2024.