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    Sample Affidavit of Indigency

    Republic of the Philippines )
    City of ______               ) S.S.
    x--------------------------x


    AFFIDAVIT OF INDIGENCY


                 I_________________, of legal age, single/married/widow, Filipino citizen, and presently residing at _____________________, after having been duly sworn to in accordance with law, do hereby depose and say:

    1.  That  I desire to avail of the free legal service of the Public Attorney’s Office.

    2.  That my monthly net salary/income is P____________. 

    3. That I am executing this affidavit to entitle me to the desired legal services. 

    IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _____________ at ______________, Philippines.


                                                                                        ________________
                                                                                                    Affiant
                                    

     SUBSCRIBED AND SWORN to before me this ____ day of ___________ in _________, Philippines, and I have read and translated the foregoing Affidavit in a dialect known and understood by him/her..

    Doc No. :  _____                                                             
    Page No.: ______                                           
    Book No.: ______                                              
    Series of 2014                                                                Public Attorney II                           

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