Republic of the Philippines )

City of Dagupan ) S.S.

x------------------------------------x

AFFIDAVIT OF THE MOTHER

I, LINDA ZAMBRANO GARIN, 43 years old, Filipino and a resident of

Barangay Nilombot, Mapandan, Pangasinan, after having been sworn to an oath in
accordance with law depose and say:

1. That I am the legitimate mother of JERICO GARIN NESPEROS, who was

born last 5 November 2015 in Region 1 Medical Center, Arellano Street, Dagupan
City, Pangasinan.

2. That I am very much willing to allow my child JERICO GARIN NESPEROS to

use the surname of the father for whatever legal purpose his birth be used.

3. That I am executing this Affidavit to attest to the truth of the following facts in
accordance with RA No. 9255.

IN WITNESS WHEREOF, I hereunto affix my signature this 29 th day of

January 2020 in the City of Dagupan, Philippines.

LINDA ZAMBRANO GARIN

Affiant

SUBSCRIBED AND SWORN to before me this 27th day of February 2020 in

the City of Dagupan, Philippines.

Administering Officer
Republic of the Philippines )
City of Dagupan ) S.S.
x------------------------------------x

AFFIDAVIT OF THE MOTHER

I, VIRGENIA FLORES BUGAYONG, 17 years old, Filipino and a resident of

413 Pantal West, Dagupan City, with the assistance of my mother CARMELA D.
FLORES, after having been sworn to an oath in accordance with law depose and
say:

1. That I am the legitimate mother of AUDRIE MAE BUGAYONG SALAZAR,

who was born last 20 July 2017 in Region 1 Medical Center, Arellano Street,
Dagupan City, Pangasinan.

2. That I am very much willing to allow my child AUDRIE MAE BUGAYONG

SALAZAR to use the surname of the father for whatever legal purpose his birth be
used.

3. That I am executing this Affidavit to attest to the truth of the following facts in
accordance with RA No. 9255.

IN WITNESS WHEREOF, I hereunto affix my signature this 29 th day of

January 2020 in the City of Dagupan, Philippines.

VIRGENIA FLORES BUGAYONG

Affiant

With My Assistance:

CARMELA D. FLORES
Mother

SUBSCRIBED AND SWORN to before me this 29th day of January 2020 in the
City of Dagupan, Philippines.

Administering Officer
Republic of the Philippines)
City of Dagupan ) S.S.
x----------------------------------x

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, MELODY DV. ROSARIO and SUSANA TERESITA M. CUALES, Filipino
citizens, both of legal age, and with residence at Bonuan Tondaligan, Dagupan City,
after having been duly sworn in accordance with law, hereby depose and say:

1. That we personally know BRYANT ANGELO M. SALAZAR and VIRGENIA

F. BUGAYONG as the parents of:

NAME DATE AND PLACE OF BIRTH

AUDRIE MAE JULY 20, 2017/REGION 1 MEDICAL CENTER,

BUGAYONG SALAZAR ARELLANO ST., DAGUPAN CITY

CHRISHNA BUGAYONG APRIL 28, 2019/REGION 1 MEDICAL CENTER,

SALAZAR ARELLANO ST., DAGUPAN CITY

2. That we are not related by consanguinity or affinity to the children’s parents;

and

3. That we are executing this Affidavit not for any remuneration whatsoever
but to attest to the truth and veracity of the foregoing statements in connection with
the registration of the birth of the above-mentioned child.

FURTHER AFFIANTS SAYETH NAUGHT.

IN WITNESS WHEREOF, we hereby affix our signatures this 29 th day of

January 2020 in the City of Dagupan, Philippines.

MELODY DV. ROSARIO SUSANA TERESITA M. CUALES

Affiant Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 29th day of January 2020

in the City of Dagupan, Philippines.
CRESENCIO D. DELA CRUZ, JR.
Public Attorney III
Pursuant to RA No. 9406