REPUBLIC OF THE PHILIPPINES)
) S.S.
I, (Name), of legal age, Filipino, married and a resident of (Address), after having been duly sworn to in accordance with law, depose and state:
1. That I am the Aunt and guardian of (Name of Minor), a minor, born on (Date of Birth of Minor), being the sister of his late mother (Mother of Minor);
2. That the above mentioned minor is under my care and custody;
3. That I am competent to receive in behalf of the said minor any amounts due her from the Social Security System, insurance firms, and other financial institutions; and
4. That I am not a vagrant, vicious, imbecile, or insane person, or a habitual drunkard or a habitual criminal, and I have not abandoned, neglected or refused to support said minor or caused her to commit offenses against the law;
5. That I am executing this affidavit to attest to the truth of all the foregoing statements and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this (Date) in (Place), Philippines.
(Name)Affiant
SUBCRIBED AND SWORN TO before me this (Date) in (Place), Philippines by (Name of Affiant) affiant exhibiting to me his Competent Evidence of Identity by way of Passport Identification(ID Number) issued on (Date) in(Place).
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 20__.