REPUBLIC OF THE PHILIPPINES )

CITY OF OLONGAPO

) S.S.

A F F I D A V I T
I, VIRGINIA MANAGO, Filipino, married, of legal age with residence and postal address
at 89-A, lower Kalaklan, Olongapo City, Zambales, after having been duly sworn to in
accordance with law, depose and state that:
1.

I was born in Olongapo City on 17 May 1957;

2.

I have been using and had been known as VIRGINIA MANAGO in our locality. I
have also signed in the said name in all of my records;

3.

Sometime last month, I obtained a copy of my Baptismal Certificate as one of

requirements in my application for Phil-Health claims for my sick mother. To my
utter disbelief, the name appearing thereon was VIRGINIA MANAGO instead of
VIRGINIA MANAGO. A copy of the said Baptismal Certificate is hereto attached
as Annex A and made an integral part hereof;

4.

Another discrepancy was noted on the Senior Citizen ID Card Number 72785
belonging to my mother; that the name CATALINA MANAGO was indicated
therein, instead of CATALINA MANAGO;

5.

In view of the foregoing, I HEREBY CERTIFY that VIRGINIA MANAGO and

VIRGINIA MANAGO, as appearing in my Baptismal Certificate, is the same
and one person:

6.

In the same manner, I HEREBY CERTIFY that CATALINA MANAGO and

CATALINA MANAGO, as appearing in Senior Citizen ID Card Number of
my mother, is the same and one person:

7.

I am executing this Affidavit to attest to the truth of the foregoing statements.

IN WITNESS WHEREOF, I have hereunto set my hands this 12th day of July 2011 here
at the City of Olongapo.

VIRGINIA MANAGO
SBMA ID No. ___________
Issued on __________
Issued at SBMA, SBFZ
SUBSCRIBED AND SWORN TO BEFORE ME this 12th day of July 2011, affiant
exhibiting to me the above cited Postal Identification Number.

Doc. No. 309;

Page No. 63;
Book No. 4;
Series of 2011.