Republic of the Philippines )

Province of Negros Oriental) s.s.

Bais City )

AFFIDAVIT OF ACKNOWLEDGEMENT/ADMISSION OF PATERNITY

I, VIRGIETO HERRERA DE LA PEÑA, of legal age, married, Filipino, and a

resident of Bliss, Bindoy Negros Oriental, Philippines, after having been duly sworn to in
accordance with law do hereby depose and state:

1. That I have one legitimate son in the name of Jade Mark Vailoces De la Peña with
my wife, Merla Vailoces De la Peña and was born on February 27, 1991;

2. That at the time he was born, we were already married unfortunately the entry of
his birth certificate was erroneously declared by my wife for reason that she will not be
discharged from the hospital if I cannot sign the said birth certificate;

3. That I am executing this affidavit to attest the veracity of the foregoing facts and
hereby solemnly swear that I am the father of Jade Mark Vailoces and he should be using my
surname De la Peña in his birth certificate.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________, at

Bais City, Negros Oriental, Philippines.

VIRGIETO H. DE LA PEÑA
Affiant
________________________

SUBSCRIBED AND SWORN to before me this _____________, at Bais City, Negros

Oriental, Philippines, affiant exhibiting to me his valid id indicated below his name and signature.

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