Republic of the Philippines)

Province of Surigao del Norte )

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SUPPLEMENTAL AFFIDAVIT

I, ___________ of legal age, Filipino Citizen, and a resident of

________________ after having been sworn to in accordance with law hereby
depose and states:

1. That I was born on _____________ and the fact of my birth was recorded
in the Local Civil Registrar of Gigaquit, Surigao del Norte;

2. That in my Local Birth Certificate, it contained all information regarding

the facts of my birth;

3. That however, in the birth certificate issued by the Philippines Statistics

Authority ( PSA ), I noticed that with respect to the entry of my
( Sex )Gender, it did not indicate whether I am a male or female;

4. That I execute this SUPPLEMENTAL AFFIDAVIT in order to request

the office of the Philippine Statistics Authority ( PSA) to supply the
Entry of my Sex ( Gender) in said birth certificate by indicating in the
entry that I am a MALE in order to conform their records of my birth
registered in their office with respect to the records of my birth certificate
registered in the Office of the Civil Registrar Gigaquit, Surigao del
Norte.

5. That further I execute this Affidavit in order to attest to the truth of the
foregoing facts and for what other purpose that this affidavit may legally
served.

In witness whereof, I have hereunto set my hand

this____________________in Claver, Surigao del Norte, Philippines.

_________________
( AFFIANT )
ID NO. _______________

Subscribed and sworn to before me this__________________in Claver,

Surigao del Norte. Philippines. Affiant showed to me her identification card
written below her name as competent proof of her identity.