REPUBLIC OF THE PHILIPPINES)

BACOLOD CITY )S.s

x-----------------------------------------------x

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, RONNIE DELA CRUZ EPOGON, of legal age, Filipino, single, and a resident of
Brgy. Handumanan, Bacolod City, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the biological father of the minor children, Kirstine Jade S. Epogon and
Rhianne S. Epogon;

2. That the biological mother of the minor children is Rhea Mae M. Suico;

3. That my children, Kirstine Jade S. Epogon, was born on March 10, 2019, and Rhianne
S. Epogon was born on November 22, 2020;

4. That at the time of birth of the above-mentioned children, I was not legally married
to their mother, Rhianne S. Epogon;

5. That I, being the father of Kirstine Jade S. Epogon and Rhianne S. Epogon, hereby
acknowledge and recognize them as my children and legal heirs;

6. That I am allowing the said minor children to use my surname EPOGON to be their
surname in their Certificate of Live Birth;

7. That I am executing this Affidavit to establish the truth of the foregoing facts and
circumstances, and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I do hereby set my and hand this _________________ in

Bacolod City, Philippines.

RONNIE DELA CRUZ EPOGON

Affiant

SUBSCRIBED AND SWORN TO before me this _____________ in Bacolod City,

Philippines. Affiant exhibited to me his TIN 627-257-966-00000 as competent evidence of his
identity.

Doc No. __________;

Page No. _________;
Book No. _________;
Series of 2024.