REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NORTHERN SAMAR ) S.S.

MUNICIPALITY OF GAMAY )

AFFIDAVIT OF ABSENCE OF MOTHER

I, DIONIE B. NUEVO JR., of legal age, single, a Filipino Citizen and a

resident of Brgy. 178, North Caloocan City, after having been duly sworn to in
accordance with the law do hereby depose and state:

1. That I am the biological son of DIONIE S. NUEVO SR. and LIONELA F.

BALASTA, who were residents of Gamay, Northern Samar;

2. That my mother, Lionela F. Balasta died when I was only 2 years old and
back then we were still residing here at the municipality of Gamay,
Northern Samar;

3. That my parents forgot to timely register my birth before the Office of the
Local Civil Registrar of Gamay, Northern Samar due to ignorance of the
provisions of the law and they thought that they need not register my
birth;

4. That I am executing this affidavit to attest to the truthfulness of the

foregoing statements and in support to the late registration of my birth at
the Local Civil Registrar of Gamay, Northern Samar and for whatever legal
purpose this document may rightfully serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of

October 2022, at Gamay, Northern Samar, Philippines.

DIONIE B. NUEVO JR.

Affiant
PhilHealth I.D. No. 21-025488610-0

SUBSCRIBED AND SWORN to before me this 19th day of October 2022 at

Gamay, Northern Samar. Affiant exhibited to me his PhilHealth I.D. bearing his
photograph and signature which serves as a competent proof of his identity.

Doc. No.______ ATTY. MIKHAEL O. SANTOS

Page No.______ Public Attorney
Book No.______ Roll of Attorneys No. 72577
Series of 2022. Pursuant to R.A. 9406