Republic of the Philippines

Province of Cagayan
Tuguegarao City

AFFIDAVIT OF CONFIRMATION

LADY DIANN B. TOBIAS

I, ______________________________________, a Filipino of legal age, a resident of
BIDDUANG, PAMPLONA, CAGAYAN
___________________________________, a bona fide member of the Philippine
National Police with the rank of PATROLWOMAN
_____________ and presently assigned at
POLICE REGIONAL OFFICE II 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 BIRTHDATE

GIANNE DHAILE B. TOBIAS
___________________________ SON
_____________ JULY 9, 2013
__________
IMELDA T. BALATUCAN
___________________________ MOTHER
_____________ JULY 1, 1972
__________
___________________________ _____________ __________
___________________________ _____________ __________
___________________________ _____________ __________

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

3. I hold myself criminally and administratively liable for perjury and dishonesty
should any statements made herein are inaccurate or later on found to be
false and in of law.

AFFIANT SAYETH NAUGHT:

_________________________
Affiant

SUBSCRIBE AND SWORN to before me this ____ day of _____________ at

________________________ Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________