Republic of the Philippines )

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

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, ZENAIDA RAMOS DELINA-CERVANTES, of legal age, Filipino Citizen,

married, with residence and postal address at 117, Caloocan Sur, Binmaley Pangasinan,
Philippines, after having been sworn to in accordance with law, hereby depose and state:

1. That I was born on August 13, 1957 at the Baguio General Hospital, Baguio City,
Philippines by the spouses Patricia Ramos Delina and Julian A. Delina as appearing in my
Certificate of Live Birth hereto attached as Annex “A” and made an integral part of this
affidavit;

2. That I have been using the name “ZENAIDA” as my first name unaware that what
was registered and recorded in my certificate of Live birth with the Local Civil Registry and
with the National Statistics Office is “BABY GIRL”. All my school records and other
equally important documents therefore contain “ZENAIDA” as my first name;

3. That the names ZENAIDA RAMOS DELINA and BABY GIRL RAMOS
DELINA who was born on August 13, 1957 at the Baguio General Hospital, Baguio City
refers to one and the same person who is the undersigned;

4. That the discrepancies might have due to inadvertency and done in honest mistake
and not intentional nor illegal;

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
first name from “BABY GIRL” to “ZENAIDA” and to endorse the same with the National
Statistics Office and for all legal intents and purposes it may properly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of April, 2016
in the City of Baguio, Philippines.

ZENAIDA RAMOS DELINA-CERVANTES

Affiant

SUBSCRIBED AND SWORN to before me this 18th day of April, 2016 in the City of
Baguio, Philippines. Affiant exhibited to me her Voter’s ID bearing VIN No. 5513-0081A-
H1357ZDC20000.

Doc. No. 378; ROMEO F. BUSLAYAN, JR.

Page No. 76; Notary Public
Book No. XXVIII; Until December 31, 2017
Series of 2016. PTR No. 2438760-Jan. 4, 2016
IBP No. 1003684-Jan. 4, 2016-Baguio-Benguet
N.A. No. 32-NC-16-R