Republic of the Philippines )

Province of Cavite ) s.s.

Mun. of Gen. Mariano Alvarez)

AFFIDAVIT OF ACKNOWLEDGMENT AND CONSENT

TO USE THE SURNAME OF THE FATHER

I, JORGE GANON NAVARRO, of legal age, with live-in partner CAROLYN TALADTAD
PIELAGO, and a resident of 1550 Brgy Pulido, Gen. Mariano Alvarez, Cavite, after having
been duly sworn in accordance with law, hereby depose and say:

1. That in my relationship with my live-in partner, a baby boy was born to us

on April 11, 2023 at Quezon Medical Center, Lucena City, whom we call
Jorge, Jr.;
2. That I admit and acknowledged my paternity and recognize him as my
son;

3. That I give my consent to use my surname “Navarro” as the surname of my

son Jorge, Jr. and henceforth he is to be known as Jorge Pielago Navarro,
Jr.

4. That I executed this Affidavit for purposes of having his name “Jorge, Jr.
Pielago Navarro” written in his Certificate of Live Birth and in his birth
records at the Local Civil Registrar of Lucena City and eventually in the
Philippine Statistics Authority.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 26 th day of

September, 2023 at Gen. Mariano Alvarez, Cavite.

JORGE GANON NAVARRO

Affiant

SUBSCRIBED AND SWORN TO before me this 26 th day of September, 2023, affiant

presented to me his Unified Multi-Purpose ID No. CRN-0113-0688455-0 issued by the Social
Security System-Carmona, Cavite, as competent evidence of his identity.

ILUMINADA M. VAFLOR-FABROA
Notary Public Until December 31,2024
Appointment No. NP 2023-01 (2023-24)
P.T.R. No. CAV6791824B 01/13/2023 PTO Cavite
IBP O.R. No. 269346 01/04/2023 Pasig City
MCLE Compliance No. VII-0012634 valid until 04-14-25
Attorney’s Roll No. 21249 3-17-67
Congressional Ave. cor. Visayas Ave., Brgy. Maderan
Gen. Mariano Alvarez 4117, Cavite, Philippines

Doc. No. 518; Page No. 5; Book No. IX; Series 2023.
Appointment No. NP 2023-01 (2023-24)