I, _____________of legal age, single/married to _____________________________and residing at _______________ and having been duly sworn in accordance with law, 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 affixed my signature this ______________ day of ____, 20 _______, in the City/Municipality of _________ , Province of ___________.