Republic of the Philippines )

Province of Cebu ) s.s.

Municipality of Carmen )

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, _______________________ and ____________________, both of

legal ages, Filipinos, and residents of _____________________, Cebu,
Philippines, after having been duly sworn to in accordance with law, hereby
depose and state, that:

1. We have been residents of _______________ Cebu, Philippines for more

than ____ years now, and during this period of time, we have personally
known _____________________________, as the mother of
___________________________________ and being our neighbors and
close acquaintance;

2. Lately, we were made aware of the problem on the Certificate of Live Birth of
______________________________________, under item number 6
(“name of mother”) of the same document as it was reflected as
_______________________________________________, the middle
name was missing one letter “L”, herein attached as “Annex A”;

3. We declare, confirm and affirm that ____________________________ and

________________________________ is one and the same person;

4. That we are executing this joint affidavit to attest to the truth and veracity of
the foregoing set of facts without any promise or reward or any other
monetary consideration but solely for the purpose of establishing the truth, to
reconcile and correct the name of ______________________________ on
the Certificate of Live Birth of her son
_______________________________.

IN WITNESS WHEREOF, we have hereunto affixed our respective

signatures this ______________________ at Carmen, Cebu, Philippines.

________________________
Affiant
Government ID No. ___________
Issued on ___________________
Issued at ____________________
_________________________
Affiant
Government ID No. _____________
Issued on _____________________
Issued at ______________________

SUBSCRIBED AND SWORN to before me this ________________ at

________________ Cebu, Philippines, the affiants exhibiting to me their
Government issued IDs written below their respective names and signature.

Doc. No.: _____;

Page No.:_____;
Book No.:_____;
Series of _____.