REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S. S.

AFFIDAVIT

The undersigned, NELSON LOMENTIGAR y IBAÑEZ, of 49

years old, married, Filipino, and presently residing at Ph 7C, Block
109, Lot 25, Bagong Silangan, Caloocan City , after having been
sworn to in accordance with the law do hereby depose and say:

1. That I am legally married to Cesar D. Dice on March 17,

2001;

2. That out of our union, we were blessed with a daughter whom

we called Kryzanne, and who was born on October 29, 2001;

3. That since the month of June 2002, my husband and I

separated and have not been living ever since;

4. That I execute this affidavit to attest to the truth and veracity

of the above foregoing and for all other legal purposes it may
serve.

AFFIANT FURTHER SAYETH NAUGHT.

ANALIZA ORTALEZA DICE

Affiant

SUBSCRIBED AND SWORN to before me this 25 th day of February,

2013, affiant personally appeared before me and exhibited her SSS
Identification Card No. 33-1823189-8, as proof of competent identity,
bearing her picture and signature.

Atty. CAROLINE C. PAYUMO

Public Attorney II
Pursuant to R.A.9406