REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN )S.S.

MUNICIPALITY OF KALIBO )
x-------------------------x

AFFIDAVIT

I, _______________, of legal age, married, Filipino, and a resident of Old,

Buswang, Kalibo, Aklan, after having been duly sworn to in accordance with law, do hereby
depose and say:

1. That I am the mother of ______________________. who is enrolled in Mapua

University, Intramuros, Manila;

2. That true and correct name of my son is ______________________. who was born
on Sept. 10, 1999 at Kalibo, Aklan based on the records of his duly authenticated
birth certificate from the Philippine Statistics Authority;

3. That I am executing this affidavit to attest to the truth of the foregoing facts for all
legal intents and purposes and I further certify that the contents of this affidavit has
been duly explained to me in the dialect that I understand and speak, that is, in the
Akeanon dialect.

IN TESTIMONY WHEREOF, I have hereunto set my hand this 4th day of July,
2018 at Kalibo, Aklan.

______________________
Affiant
SSS ID Card No. 07-1609896-6;

SUBSCRIBED AND SWORN to before me this 4th day of July, 2018 at Kalibo,
Aklan.

Doc. No. 88;

Page No. 19;
Book No. VI
Series of 2018.