Republic of the Philippines

City of Tacloban

)
) S.S.

AFFIDAVIT OF THE MOTHER

I, ROBILYN SOMBISE VERMUG, of legal age, Filipino citizen and
a resident of Tacloban City, after having been sworn to an oath in
accordance with law, hereby depose and state: THAT--1. I am the legitimate mother of NIKKA MAE S. VERMUG, who was
born on 15 January 2009 at Tacloban City, with Certificate of Live Birth
Registry No. 2009-0640 of the Office of the Civil Registrar of Tacloban
City;
2. I am very much willing to allow my daughter NIKKA MAE S.
VERMUG to use the surname of her father, NIKKO S. GIRON, for
whatever legal purpose her birth be used;
3. I am executing this affidavit to attest to the truth of the
foregoing facts in accordance with R.A. 9255.
IN WITNESS WHEREOF, I have hereunto set my hand this 28
June 2011 at Tacloban City, Philippines.
ROBILYN S. VERMUG
Affiant
SUBSCRIBED AND SWORN to before me this 28 June 2011 in
Tacloban City by ROBILYN S. VERMUG, personally known to me, who is
the same person who personally signed before me the foregoing
affidavit and acknowledged that he executed the same.
Doc. No. ____
Page No. ____
Book No. ____
SERIES OF 2011