REPUBLIC OF THE PHILIPPINES )

Done in the ________________) S.S.

AFFIDAVIT OF GUARDIANSHIP

I, _____________________, of legal age,

single/married/widow/widower, with residence at
______________________________, under oath in accordance with the law,
hereby declare that:

1. I am the

Grandparent
Older Brother
Older Sister
Actual custodian, (state relationship with the athlete)
of ________________________________, an athlete competing in
the 2017 Palarong Pambansa.

2. I am the acting guardian over the person of the above-mentioned

athlete;

3. I am of sound mind, of good moral character, responsible, and not

otherwise disqualified by law to serve as guardian over the person of
the above-mentioned minor;

I am executing this affidavit to attest to the truthfulness of the foregoing

statements and for the purpose of giving my consent for my ward to
participate in the 2017 Palarong Pambansa.

IN WITNESS WHEREOF, I have hereunto set my hand this __________

day of __________________ 2017 in _____________________, Philippines.

GUARDIANS NAME
Affiant-Declarant

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 SUBSCRIBED AND SWORN to before me this ___________of
__________ 2017 in ________________, affiant-declarant personally appeared
and presented to me his/her (government issued id) bearing the numbers
________________ issued on _______________ in
_______________________. After personally examining the affiant, I am
convinced that she read and understood the content of this affidavit and that
this is his/her free and voluntary act.

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

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