Affidavit of Guardianship

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REPUBLIC OF THE PHILIPPINES CITY OF GENERAL SANTOS

S.S

AFFIDAVIT OF GUARDIANSHIP
I, QUELIRINA ARCALA TANTE, of legal age, married, Filipi o a d !i"# re$ide %e a" P&ro' (a$& &ri , Bara ga) Sa I$idro, Ge eral Sa "o$ Ci"), af"er *ei g $!or "o i a%%orda %e !i"# la! do #ere*) depo$e a d $a)+ T#a" I am a la!f&l $i$"er of "#e la"e CELESTINA B. ARCALA !#o i$ "#e legi"ima"e mo"#er of CRISTY JANE B. ARCALA, ,- )ear$ of age+ T#a" a$ #er la!f&l $i$"er, I em*ra%ed a d "oo' %are of #er %#ild a d m) CRISTY JANE B. ARCALA, pro.idi g #er *a$i% eed$+ ie%e,

T#a" a$ a la!f&l g&ardia of CRISTY JANE B. ARCALA , I am re/&e$"i g "#e Na"io al S"a"i$"i%$ Offi%e "o relea$e a a&"#e "i%a"ed %op) of #er *ir"# %er"ifi%a"e+ T#a" I am e0e%&"i g "#i$ affida.i" "o a""e$" "#e "r&"#f&l e$$ a d .era%i") of "#e foregoi g $"a"eme "$.

IN WITNESS WHEREOF, I #a.e #ere& "o $e" m) #a d "#i$ -"# da) of Fe*r&ar), 12,3, i "#e Ci") of Ge eral Sa "o$, P#ilippi e$.

QUELIRINA ARCALA TANTE Affia "


Philhealth No. 17-025290498-3

SUBSCRIBED AND SWORN "o *efore me, "#i$ -"# da) of Fe*r&ar), 12,3 a" Ge eral Sa "o$ Ci"), P#ilippi e$, affia " e0#i*i"ed "o me #er I4 No. !ri""e *elo! #er ame.

Doc. No: P#$% No. Boo' No. S%)*%+ o,

9 ! 20! (((III ! 2014.

ATTY. JOSE EDMAR J. YUMANG NOTARY PUBLIC, GSC DECEMBER 31, 2015 ROLL NO. 57439 IBP NO. 9423"9 TIN NO. 1 1&923&9 " PTR NO. 00000GS&530191
MCLE COMP. NO. I-&001534 .4/0 Co123*#4c% 2%)*o56

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