Republic of the Philippines)

Province of XXX XXX) S.S.

Municipality of XXX XXX)
x--------------------------------x

AFFIDAVIT OF CONFIRMATION
I, XXX XXX XXX, Filipino, 37 years old, presently residing in XXX XXX, member
of the Philippine National Police with the rank of POLICE CORPORAL and presently
assigned at XXX XXX XXX, after having been duly sworn to in accordance with law
hereby depose and say that:

1. Pursuant to this affidavit, I am confirming that the following are my legal

beneficiaries and/or heirs, to wit:

Name Relationship Birthdate

XXX XXX XXX

2. My relationship with the persons whose names are listed above are borne out
by the fact that I am the father and the son of the aforesaid persons as
evidenced by the attached Birth Certificates, Advisory on Marriages, and
Marriage Contract;

3. That all the documents I have attached and submitted to support the updating
of my DLB are original copies obtained from Philippine Statistics Authority
(former NSO); and

4. I hold myself criminally and administratively liable for perjury and dishonesty
should any statements made herein/documents submitted herewith are
inaccurate or later found to be false and in violation of law.

5. I am executing this affidavit to attest to the truthfulness of the foregoing

statements.

XXX XXX XXX XXX XXX

Affiant
PNP ID: XXX XXX
Contact No. XXX XXX

SUBSCRIBED AND SWORN to before me this 28th day of March 2019 at XXX
XXX XXX XXX.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019