Republic of the Philippines)

Province of Cebu) S.S.

City of Mandaue
x--------------------------x

AFFIDAVIT OF ACKNOWLEDGEMENT

I, Raymond Ilustrisimo, Filipinos, of legal age, married and presently residing at

Zone Ahos, Paknaan, Mandaue City, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

1. That am the biological father of Janiel Medequillo, conceived and born on

June 20, 2007 at Sitio Rosal St. Hernan Cortes, Banilad, Mandaue City, Cebu
and the child of Lewa Medequillo. Attached here is a copy of the Certificate of
Live Birth and made integral part hereof as Annex “A”.

2. That at the time of her birth I was not legally married to her mother, hence
she is my illegitimate child and being born out of wedlock.

3. That I hereby admit under oath the paternity of Janiel Medequillo and wants
her name changed from “JANIEL MEDIQUILLO” to “JANIEL MEDIQUILLO
ILUSTRISMO”.

4. That we execute this affidavit to declare the truth of the foregoing facts.

IN WITNESS WHEREOF, we have hereunto set our hands this November 10, 2018 at
Mandaue City, Philippines.

RAYMOND ILUSTRISIMO
Affiant

SUBSCRIBED AND SWORN to before me this 10 th November, 2018 at

Mandaue City, Philippines, by affiant who presented to me his UMID No. 0006-
2635228-4.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.