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Affidavit of Single Status

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Republic of the Philippines)

Bayambang, Pangasinan)

AFFIDAVIT OF SINGLE STATUS

I, _________________________, of legal age, Filipino, with residence address at


Bayambang, Pangasinan, after having been duly sworn to in accordance with law, do hereby
depose and say, that:

1. I have never contracted any marriage in the Philippines or elsewhere and I remain SINGLE
to this very day and hour;

2. I have no child born at the time of the execution of this Affidavit;

3. I am executing this Affidavit for the purpose of complying with the requirements in
connection to my job application.

4. I declare that the statements made in this affidavit are true and correct and I am willing
to bear all the legal responsibilities arising therefrom.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of October 2019 at the
Municipality of Bayambang, Pangasinan.

___________________
Affiant

SUBCRIBED AND SWORN TO before me this 7th day of October 2019 at the Municipality
of Bayambang, Pangasinan, affiant exhibiting her School Issued ID No. ________________,
issued by PSU Bayambang Campus, Philippines.

NOTARY PUBLIC

Doc No. 296;


Page No. 61;
Book No. I;
Series of 2019.

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