Republic of the Philippines )

) S.S.
Done in the City of Baguio )

AFFIDAVIT OF SUPPLEMENTAL REPORT

(Re: First Name of a Person)

I, APO1 SHEFTON DALILIS y Wayas, of legal age, Filipino Citizen, married, with
residence and postal address at 47 Maria Basa Street, Baguio City, Philippines, after having been
sworn to in accordance with law, hereby depose and state, that:

1. I am the Attorney-in-Fact of ROMEO LABADOR y Lopez was born on December 2,

1958 at the Baguio General Hospital, Baguio City, Philippines by the spouses Salvador Labador and
Dorothea Lopez-Labador as appearing in his Certificate of Live Birth hereto attached as Annex “A”
and made an integral part of this affidavit;

2. He has been using the name “ROMEO” as his first name unaware that what was registered
and recorded in his certificate of Live birth with the Philippine Statistics Authority (PSA) is “BABY
BOY”, so that, all his school records and other equally important documents contain “ROMEO” as
his first name and the same might be due to the fact that when he was born, his parents were not yet
ready with what they will name him and not done for any illegal motive or purposes whatsoever;

3. The names ROMEO LABADOR y Lopez and BABY BOY LABADOR y Lopez who
was born on December 2, 1958 at the Baguio General Hospital, Baguio City, Philippines refers to one
and the same person who is the undersigned’s principal;

4. I am now requesting the Local Civil Registry of Baguio City to Supplement the name of my
principal from “BABY BOY” to “ROMEO” and to endorse the same with the Philippine Statistics
Authority;

5. That I am executing this affidavit to attest to the truth and veracity of its contents and for
the purpose of requesting the Local Civil Registry of Baguio City to supplement my principal’s first
name from “BABY BOY” to “ROMEO” and to endorse the same with the Philippine Statistics
Authority (PSA) and for all legal intents and purposes it may properly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of December 2017 in
the City of Baguio, Philippines.

APO1 SHEFTON DALILIS y Wayas

Affiant

SUBSCRIBED AND SWORN to before me this 11 th day of December 2017 in the City of
Baguio, Philippines. Affiant exhibited to me his PRC ID (Criminologist) No. 0089709, valid until
September 26, 2020, issued by the PRC.

ROMEO F. BUSLAYAN, JR.

Notary Public for Baguio City
Until December 31, 2017
PTR No. 2923279-Dec. 22, 2016-Baguio City
IBP No. 1039786-Dec. 22, 2016-Baguio-Benguet
N.A. No. 32-NC-16-R

Doc. No. 371; Page No. 75; Book No. XLI; Series of 2017.