AFFIDAVIT OF SOLE GUARDIANSHIP

I, _________________, of legal age, married, Filipino, and a resident of

__________________after having been duly sworn to in accordance with law, hereby
depose and say that:

1. _________________, 14years old, is my nephew who has

been under my custody since birth;

2. Since his birth, I have been acting as the sole guardian of

__________________________, he has been living in my house and I am
the one who has been providing for his day-to-day needs up to the
present;

3. This affidavit is executed in order to attest to the

truthfulness of the foregoing facts and for whatever legal purposes that
this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 08 May 2017,

in Bacolod City, Philippines.

_____________________
__________________
VIN 4501-1027A-__________________

Republic of the Philippines - - - - -)

Bacolod City - - - - - - - - - - - - - - ) Sc.
x - - - - - - - - - - - - - - - - - - - - - -x

SUBSCRIBED AND SWORN TO before me this 08 May 2017, in the place first
above-mentioned, Affiant appeared to me and showed her competent proof of identity
as noted above.

Witness my hand and seal.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017.