Republic of the Philippines)

City of Davao )
). . .s.s.

AFFIDAVIT OF CONFIRMATION

I, Von Ramcy Pepito Garcia, a Filipino of legal age, a resident of B3L8P2 Canada
St., Vista Verde Village, Panacan, Davao City a bona fide member of the
Philippine National Police with the rank of Police Staff Sergeant (PSSg) and
presently assigned at Health Service-Regional Health Service 11 (RHS 11) after
having been duly sworn to in accordance with law, Do hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal

beneficiaries and/or heirs, to wit:

NAME RELATIONSHIP BIRTH DATE

Venus May Pilapil Soriano Wife February 08, 1984

James Von Soriano Garcia Son January 13, 2016
Leanne Delos Santos Garcia Daughter March 17, 2013

2. My relationship with persons whose names are listed above are borne out
by the fact that I am the lawful spouse and the father/mother of the afore-
named children as evidenced by the attached advisory on manages,
marriages, marriage contract and birth certificates;

3. That all the documents I have attached and submitted to support the
updating of DLB are original copies obtained from Philippine Statistics
Authority; and

4. I hold myself criminally and administratively liable for perjury and

dishonesty should any statements made herein/documents submitted
herewith are inaccurate or later found to be falls and in violation of law.

AFFIANT SAYETH NAUGHT:

PSSg Von Ramcy Pepito

Garcia
Affiant
Contact No: 09303212116

SUBSCRIBE AND SWORN to before me this _____day of _________ at

______________________________ Davao City, Philippines.

Doc No. ____________

Page No. ___________
Book No. ___________
Series No. __________