REPUBLIC OF THE PHILIPPINES) : S.S.

IN THE CITY OF PARAÑAQUE )

x---------------------------------------------x

AFFIDAVIT SOLO PARENT

I, PIO CINCO DOZA, JR., of legal age, single, Filipino and presently
residing at #073 Fatima St., San Antonio, Valley 1, Parañaque City, after having
been duly sworn to in accordance with law, hereby depose and say:

1. That I have three (3) children with my former live-in partner, ELMA L.
CAGAY, namely;

a. MARIA CRISTINA, 6 years old;

b. PRINCESS RHIANN, 4 years old; and
c. KENT JUSTIN, 1 year old;

2. That two of our children, Maria Cristina and Princess Rhiann, are under
the custody of their mother, Elma, and currently residing in Malabon City;

3. That our child, Kent Justin, who was born in Magtalas Birthing Home, 103
Panghulo Rd., Panghulo, Malabon City, is already under my custody and I
am the only one left to sustain all his needs, thus, I stand as a solo parent
from that time on; and

4. That I am executing this Affidavit to attest to the truth of the foregoing facts
and for whatever legal purpose and intent it may serve.

IN WITNESS WHEREOF, I have hereto affixed my signature this 3rd day

of January 2018 in the City of Parañaque, Philippines.

PIO CINCO DOZA, JR.

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _________

2018 at Parañaque City.

NOTARY PUBLIC

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of ____