Republic of the Philippines )
City of Cabadbaran ) S.S.
x--------------------------x
AFFIDAVIT OF GUARDIANSHIP
I, JULITA C. MEÑOSA, of legal age, married, Filipino citizen, and a resident
of Brgy. 9, Bacolod City, Negros Occidental, after having been duly sworn to in
accordance with law, do hereby depose and say:
1. That I am the grandmother and guardian of the following minor whose Birth
Certificate is being processed with the Philippine Statistics Authority, to wit:
Full Name of Minor Date of Birth Age
ANDRIA M. TRINIDAD May 25, 2012 7
2. That the above-mentioned minor is under my care and custody;
3. That I am competent to certify in behalf of their parents in the processing of her
Birth Certificate and for whatever legal purpose;
4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual
drunkard or a habitual criminal, and have not abandon ed, neglected or refused
to support said minors or caused them 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 _____________
at Bacolod City, Negros Occidental, Philippines.
JULITA C. MEÑOSA
Affiant
SUBSCRIBED AND SWORN to before me this ________________ at
Bacolod City, Negros Occidental, Philippines, affiant exhibiting to me her competent
evidence of identity _____________________________.
Doc No. : ____
Page No.: ____
Book No.: ____
Series of 2019.