Republic of the Philippines City of Ormoc

) ) SS

AFFIDAVIT TO SUPPLY NAME

I, LOYD T. MORRIEL, of legal age, Filipino, married and a resident of Ormoc City, after having been sworn according to law, hereby depose and state: THAT--1. I am the father of NICE S. MORRIEL, who was born on MAY 18, 1988 in Ormoc City; 2. The said birth was registered with the Office of the Local Civil Registrar of Ormoc City, but his first name was left blank, as I have not yet decided on a name to give him upon registration. 3. Subsequently upon baptism, he was given the name NICE S. MORRIEL, the name he has been using since then. 4. Unfortunately, due to inadvertence, I failed to supply his first name in his Certificate of Live Birth with the Local Civil Registrar of Ormoc City up to this time. 3. I am executing this affidavit to attest to the truth of the foregoing facts and to further supply the true and real name of my daughter in his birth registry No. 867 (d-86). IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of Septmeber, 2011 at Ormoc City, Philippines. LOYD T. MORRIEL
Affiant/Father

SUBSCRIBED AND SWORN to before me this 2nd day of September , 2011 at Ormoc City, affiant exhibiting to me his CTC No. 19047959 issued on August 30, 20011 at Ormoc City, Philippines. Doc. No. ____ Page No. ____ Book No. ____ SERIES OF 2011