Republic of the Philippines]

City of Legazpi ] s.s.

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

AFFIDAVIT OF GUARDIANSHIP

I, FATIMA BANZUELA AZUPARDO, of legal age, Filipino, single, with address at Purok No. 2,
Buyuan, Legazpi City, after having been duly sworn to in accordance with law, do hereby depose and
state:

1. That I am the biological mother and guardian of minor who has an interest in applying for
a DOST Scholarship and for whatever legal intent:

Full Name of Minor/s Date of Birth Age

KRISHTINE PATRICIA AZUPARDO December 10, 2000 17

2. That the above mentioned minor is under my care and custody;

3. That I am not imbecile, insane, a vagrant or a vicious person or a habitual drunkard or a

habitual criminal, and have not abandoned, neglected or refused to support the said
minor or caused her to commit offenses against the law;

4. That I am executing this affidavit to attest to the truth of all the foregoing statements
and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this August 2, 2018 at Legazpi City,
Philippines.

FATIMA BANZUELA AZUPARDO

Affiant
VIN: BNBB-0000A-J1373FBA20000

SUBSCRIBED AND SWORN to before me this August 2, 2018 at Legazpi City, Philippines.
Affiant exhibited to me her Identification Card indicated below her name as competent proof of
identity pursuant to the 2004 Rules on Notarial Practice.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.