Republic of the Philippines)

City of Dipolog) S. S.

AFFIDAVIT OF BIRTH

I, Elizabeth Antenero Andig, of legal age, Filipino, and a resident of Purok

7, Barangay Matam, Katipunan Zamboanga del Norte after being sworn
according to law, hereby depose and say:

1. That I am attesting on behalf of Mary Grace Antenero Andig for her

application for Certification of Declared Legal Beneficiaries;

2. That I am the mother by birth of the applicant;

3. That she was born on August 19, 1990 at Matam, Katipunan,

Zamboanga del Norte at 7:43 in the evening;

4. That affidavit of birth is offered in lieu of birth certificate because

of the urgency of submission of documents for application of CDLB
and her scheduled transaction in PSA cannot be awaited.

5. That this affidavit is executed to attest to the truth of the foregoing

and for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of

January 2023 at Sicayab, Dipolog City, Zamboanga del Norte.

ELIZABETH ANTENERO ANDIG

Affiant

SUBSCRIBED AND SWORN to before me this 27 th day of January 2023

at Sicayab, Dipolog City, Zamboanga del Norte, with affiant exhibiting her
Driver’s License with License Number J05-18-002209, issued on July 23, 2020
at Ipil, Zamboanga Sibugay.

MERRIAM DEFENSOR SANTIAGO

NOTARY PUBLIC
Until December 31, 2023

Doc. No. : 12345

Page No. : 12
Book No. : 123
Series of 2023.