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