REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU ) S.S.

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, ALFREDO GUEVARA TEMPLADO, of legal age, Filipino and a resident of

503C 1ST ST., LA GUARDIA LAHUG, CEBU CITY, Philippines, after having been duly
been sworn to in accordance with law, do hereby depose and say:

That I am the subject child with the Certificate of Live Birth under the name
of BABY TEMPLADO who was born on APRIL 14, 1951 at CEBU MATERNITY
HOUSE, Cebu City, Cebu;

That my Certificate of Live Birth with the name BABY TEMPLADO is

registered in the Local Civil Registrar of Cebu City under Registry Nos. 1904.
However, the information anent the CHILD’S FIRST NAME therein reflected the
entry of “BABY” which at that time is considered as an omission of entry as the
attendant-at-birth must have inadvertently forgotten my first name, thus omitting
the same at the time when she prepared the concern Certificate of Live Birth prior
to its registration at the Civil Registrar’s Office concerned;

That I am executing this affidavit in good faith to attest to the veracity of

the foregoing facts for all legal intents and purposes and likewise to supply the
information anent the CHILD’S FIRST NAME “ALFREDO”, as recorded in the
COLB and filed with the office concerned, in conformity with the enclosed
supplemental report.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27TH day

of February, 2017 in Cebu City, Philippines.

ALFREDO G. TEMPLADO
Affiant
DRIVER’S LICENSE
ID # N02-74-007505

SUBSCRIBED AND SWORN TO before me this __________________ in Cebu

City, affiant exhibited to me competent evidence of identity indicated below their
names.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017.

ATTY. LECEL R. LLAMEDO

NOTARY PUBLIC
COMMISSION EXPIRES ON DECEMBER 31, 2011
NOTARIAL COMMISSION NO. 075-10
ROLL NO. 57485
IBP NO. 823559-12/07/2010-Cebu City
PTR NO. 0800058-01/03/2011-Cebu City