You are on page 1of 5

Republic of the Philippines.

)
City of Zamboanga ..)S.S.
For Zamboanga del Sur)
x------------------------------------x)

AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION
OF PATERNITY
I, SATURNINO V. COSEP, of legal age, married, Filipino and a resident of Solar,
Olutanga, Zamboanga del Sur, Philippines, after having been duly sworn to an oath in
accordance with law hereby depose and state:
1

That I am the natural and biological father of GEMMALYN P. COSEP


and the legitimate daughter of Evangeline F. Perez, who was born on
December 8, 1988;

That I am, therefore, acknowledging GEMMALYN P. COSEP as my


biological and natural daughter as I hereby grant her the use of the
family name COSEP;

I am executing this affidavit in order for my biological daughter to


carry my surname in all her documents and papers and for all legal
intents and purposes.

This 17th day of August, 2002 at Zamboanga del Sur, Philippines.


SATURNINO V. COSEP
Affiant
ROSALITA ROJAS
Witness

RAYMUNDO COSEP,Jr.
Witness

SUBSCRIBED AND SWORN TO BEFORE ME, this 17th day of August, 2002 at
Zamboanga del Sur, Philippines.

Doc. No. 21;


Page No. 05;
Book No. 91;
Series of 2002.

ATTY. BERARDO C. FAUNDO, Jr.


Notary Public
Until December 31, 2002
PTR No. 0009126161; 01-05-2002
Notarial Com. No. 020-2002
IBP No. 527797; 12-27-2002
Roll of Attorney No. 37073
Nuez St. Ext., Zamboanga City

REPUBLIC OF THE PHILIPPINES}


ZAMBOANGA CITY ..}S.S.

AFFIDAVIT
I, GEMALYN P. COSEP, of legal age, married, Filipino, and a resident of Ipil,
Zamboanga Sibugay, Philippines, after having sworn in accordance with law, do hereby
depose and state:
1. That I am a member of Pantawid Pamilyang Pilipino Program at
Ipil, Zamboanga Sibugay;
2. That as a member thereof, I am required to correct my Birth
Certificate and Marriage Contract entries;
3. That some discrepancy of entries of the following documents
hereunder avers:

DOCUMENT

DISCREPANCY

TRUE/CORRECT

DEP-ED FORM 137-E


First Name- GEMMALYN
GEMALYN
BIRTH CERTIFICATE
Fathers Name- Raimundo V. Cosep Saturnino Villaplana
BIRTH CERTIFICATE
Mothers Status- married
single
MARRIAGE CONTRACT
First Name- GEMMALYN
GEMALYN
MARRIAGE CONTRACT
Date of Birth- Dec. 9, 1988
Dec. 8, 1988
4. That the above discrepancy of entries is one and the same person of
GEMALYN P. COSEP, who is a legitimate child of Evangeline F. Perez
and Saturnino Villaplana and the same was born on December 8, 1988;
5. I am executing this affidavit to attest to the truth of the foregoing
statements and to correct the entries and for whatever legal purposes
this may serve.
IN

WITNESS

WHEREOF,

have

hereunto

affixed

my

signature

this

____________________, at Zamboanga City, for Zamboanga Sibugay, Philippines.

GEMALYN P. COSE
Affiant
SUBSCRIBED AND SWORN to before me this _____________________, at
Zamboanga City, for Zamboanga Sibugay, Philippines.

REPUBLIC OF THE PHILIPPINES}


ZAMBOANGA CITY ..}S.S.

AFFIDAVIT OF DISCREPANCY AND LOST

I, NOEL INTAC SALATAN, of legal age, married, Filipino, and a resident of Gov.
Ramos, Sta. Maria, Zamboanga City, Philippines, after having sworn in accordance
with law, do hereby depose and state:
6. That I am a bonafide member of Phil Health and registered under no.
14-000004895-6;
7. That one of my beneficiaries is my mother, AQUILINA INTAC SALATAN,
85 years of age, under my custodial care and presently confined at
Ciudad Medical, Zamboanga City due to various ailments;
8. That in her Phil Health Record, her Date of Birth is May 17, 1928 which
is her true and actual date of birth as appearing in her Birth
Ccertificate and other public documents. However, in her medical
records with Ciudad Medical, Zamboanga City, her Date of Birth is May
15, 1928;
9. That in the same Philhealth Record, her middle initial appears as I.
The same stands for the name INTAC;
10.That the Birth Certificate in her possession was damaged together
with her Marriage Contract, Senior Citizen I.D. and other documents
due to termite infestation in her room, hence, we decided to dispose
them;
11.That I am executing this affidavit of discrepancy and loss to attest to
the truth of the foregoing facts and to establish the damage and loss
of the above-stated documents.
IN

WITNESS

WHEREOF,

have

hereunto

affixed

my

signature

this

____________________, at Zamboanga City, Philippines.

NOEL INTAC SALATAN


Affiant
PIN 14-000004895-6
SUBSCRIBED AND SWORN to before me this _____________________, at
Zamboanga City, Philippines.