Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of Alangalang )

AFFIDAVIT OF MOTHER
I, MAMA SANG, of legal age, Filipino, and a resident of Blk.6 Lot 6 Phase
6 Pegasus Subd. Malandi, Makati City, after having been sworn to an oath in
accordance with law, hereby depose and sayeth:

THAT I am the LEGITIMATE mother of XANDER FORD, who was born last
November 01, 1999 in Makati City;

THAT I am very much willing to allow my son to use the surname of the
father for whatever legal purpose his birth be used;

THAT I am executing this affidavit to attest to the truth of the foregoing facts
in accordance with RA 9255.

IN WITNESS WHEREOF, I hereunto affix my signature this

_______________ at Makati City.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this ___________________ at

Makati City, Philippines.

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