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Republic of the Philippines )

______________________________ )

AFFIDAVIT
[OF RECOGNITION OF LEGAL GUARDIANSHIP]

I, [STATE NAME OF PARENT (BOLD)], Filipino, [STATE CIVIL STATUS


(single/married/widowed)], of legal age, with address at [STATE COMPLETE
ADDRESS], after having been duly sworn in accordance with law, hereby depose and
say that:

1. I am the mother and legal guardian of the minor [STATE FULL NAME OF
YUAN (Bold)], whose date of birth is on [STATE YUAN’S BIRTHDAY], as
evidenced by his Certificate of Live Birth, a copy of which is hereto attached as
ANNEX “A”.

2. There is no other judicially appointed guardian over the person or property of


[STATE FULL NAME OF YUAN (Bold)] other than myself.

3. [STATE FULL NAME OF YUAN (Bold)] was abandoned by [STATE FULL


NAME OF YUAN’S BIOLOGICAL FATHER (Bold)] when he was three (3)
months old.

4. Said [STATE FULL NAME OF YUAN’S BIOLOGICAL FATHER (Bold)]


failed to help me with the hospital bills when I gave birth to [STATE FULL
NAME OF YUAN (Bold)] despite his recognition of paternity of [STATE
FULL NAME OF YUAN (Bold)].

5. When [STATE FULL NAME OF YUAN (Bold)] was already nine (9) months
old, he was under the custody of [STATE FULL NAME OF GERRON’S
MOTHER], who is my [STATE RELATION WITH GERRONS MOTHER].

6. [STATE FULL NAME OF YUAN (Bold)] has not been adopted by another.

7. I have NOT ever been judicially declared as having abandoned [STATE FULL
NAME OF YUAN (Bold)].

8. I have NOT ever been judicially declared as absent or incapacitated to exercise


parental authority over the person and/or property of [STATE FULL NAME
OF YUAN (Bold)].

9. I have NEVER been divested of parental authority over the person and/or
property of [STATE FULL NAME OF YUAN (Bold)].

10. I have NEVER been convicted of any crime which carries with it the penalty of
civil interdiction.

11. Considering that I have to make a living for myself and [STATE FULL NAME
OF YUAN (Bold)], I was constrained to leave the custody of [STATE FULL
NAME OF YUAN (Bold)] to [STATE FULL NAME OF GERRON’S
MOTHER].

12. I am RECOGNIZING the substitute parental authority of [STATE FULL


NAME OF GERRON’S MOTHER] over my child [STATE FULL NAME OF
YUAN (Bold)] in so far as it concerns the discipline, education and other
decision making with regard to his custody.

13. That I am executing this Affidavit to attest to the truth of the foregoing facts and
for other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____


day of ______________ 2018, at _______________, Philippines.

[NAME OF YUAN’S MOTHER]


Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of


____________ 2018 at _________________, Philippines, the Affiant exhibiting her
______________________________ issued on __________at _____________as
competent evidence of identity.

Doc. No. ____


Page No. ____
Book No. ____
Series of 2018.