REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT OF MISDECLARATION OF MARRIAGE

I, ANAMOR S. BAES, Filipino, of legal age, married to Eric Baes and a
resident of Philippine Railway Street, Brgy. X, Roxas City, Capiz after
having been duly sworn in accordance with law, hereby depose and
state THAT:

1. I am the same ANAMOR S. BAES, who is the affiant herein;

2. I was married to Eric Baes on 14 October 2010 as evidenced

by our Marriage Certificate;

3. Sometime in 2014, I planned to work abroad as a nurse. Thus,

I started processing my requirements which include securing
passport;

4. Due to the fact that I was given short period of time to finish
all the requirements, I inadvertently and erroneously
declared that I was single at the time that I applied for
passport in the DFA Iloilo;

5. I also failed to submit the necessary document evidencing the

fact that I was married at that time;

6. In order to correct the entry in my passport and for the

renewal of the same, I decided to change my surname in
accordance to the surname of my husband or from
SOGUILON to BAES since I am already married and I already
adopted the surname BAES;

7. Hence, this affidavit is being executed to explain this mishap;

8. I attest to the veracity of the above affirmation.

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day

of March, 2020 at the Roxas City, Philippines.

ANAMOR S. BAES
PhilHealth I.D No. 11-025267004-1

SUBSCRIBED AND SWORN to before me this 11th day of March

2020, in the City of Roxas, Philippines. I further CERTIFY that I have
personally examined the affiant, and I am fully satisfied that she
voluntarily executed the foregoing Affidavit, and she read and
understood the contents thereof.