REPUBLIC OF THE PHILIPPINES)

CITY OF ILIGAN )S.S

AFFIDAVIT OF ONE AND THE SAME PERSON

I, MOHMINA P. PANTARAN, of legal age, Filipino citizen,

married and a resident of Mars Street, Rabago Subdivision, Iligan
City, after having been sworn in accordance with law hereby dipose
and say:

1. That, I am HADJI MOHMINA P. PANTARAN as stated in

the medical records found in Adventist Medical Center;
2. That, I have used the prefix “HADJI” on my medical
documents for it is required of us, Muslims when we have
successfully completed the “Hajj” pilgrimage to Mecca,
Saudi Arabia;
3. That, I am executing this affidavit to attest that “HADJI
MOHMINA P. PANTARAN” as appearing on my medical
records and “MOHMINA P. PANTARAN” as appearing on
my personal identification cards e.i. (Senior Citizen ID), are
ONE AND THE SAME PERSON;
4. That, I am executing this affidavit to attest to the
truthfulness and honesty of the foregoing facts and for all
intents and purposes it may serve.

Further affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th

day of August 2019 in the City of Iligan.

____________________
Affiant

SUBSCRIBED AND SWORN to before me this 16 th day of August

2019, by affiant who exhibited to me her _______________ ID issued
on _______________ at _______________.

____________________
Notary Public

Doc. No. _____

Page No. _____
Book No. _____
Series of _____