21-SSQUEJFD - Affidavit of Family Financial Capacity
21-SSQUEJFD - Affidavit of Family Financial Capacity
_______________________________) S.S.
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__ Single/Solo Parent
✓ Married
__ Married, separated
Civil Status
__ Widower
__ Deceased
__ Unknown whereabouts
__ Employment
Name of Employer: _______________________________________
__ Informal Employment
(Tricycle/jeepney/pedicab driver, manicurist, barber, etc.)
Source of Income
please specify: _______________________________________
__ Micro/Small business (Sari-sari store, direct selling, etc.)
please specify: _______________________________________
__ None
Pension Php 0.00
Signature
I hereby confirm that I am aware that any willful, unlawful, and untruthful statement or falsehood upon
material matters stated in this affidavit and/or required by this voucher application, as well as other
violations of the Guidelines on Eligibility and Application for the Senior High School Voucher Program in SY
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2021 - 2022 issued by DepEd, will disqualify/exclude the voucher applicant and may bar the learner from
other Government Assistance and Subsidies (GAS) programs by DepEd, without prejudice to applicable
administrative and criminal remedies that may be pursued against me and/or all proper parties.
I am executing this affidavit to attest to the truth of the foregoing facts and statements.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of _________, 2021 at
________________________________, Philippines.
___________________________________
Affiant
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REPUBLIC OF THE PHILIPPINES)
_______________________________) S.S.
Page 4 / 6
__ Single/Solo Parent
✓ Married
__ Married, separated
Civil Status
__ Widower
__ Deceased
__ Unknown whereabouts
__ Employment
Name of Employer: _______________________________________
__ Informal Employment
(Tricycle/jeepney/pedicab driver, manicurist, barber, etc.)
Source of Income
please specify: _______________________________________
__ Micro/Small business (Sari-sari store, direct selling, etc.)
please specify: _______________________________________
__ None
Pension Php 0.00
Signature
I hereby confirm that I am aware that any willful, unlawful, and untruthful statement or falsehood upon
material matters stated in this affidavit and/or required by this voucher application, as well as other
violations of the Guidelines on Eligibility and Application for the Senior High School Voucher Program in SY
Page 5 / 6
2021 - 2022 issued by DepEd, will disqualify/exclude the voucher applicant and may bar the learner from
other Government Assistance and Subsidies (GAS) programs by DepEd, without prejudice to applicable
administrative and criminal remedies that may be pursued against me and/or all proper parties.
I am executing this affidavit to attest to the truth of the foregoing facts and statements.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of _________, 2021 at
________________________________, Philippines.
___________________________________
Affiant
Page 6 / 6