REPUBLIC OF THE PHILIPPINES )

CAMILING, TARLAC ) S.S

AFFIDAVIT
I, IMELDA ARELLANO VICTORIO, of legal age, Filipino citizen, single, and a
resident of Romulo St., Poblacion A, Camiling, Tarlac, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and state THAT:

1. I am the mother of JAMEL ERICA VICTORIO (Jamel Erica, for brevity), who
was born on September 30, 2000;

2. Jamel Erica despite being a minor begot a child named TRACEY NICOLE
VICTORIO GOLINGAN born on May 26, 2017 at the Gilbert Teodoro
Memorial Hospital, Camiling, Tarlac with Kyle Ceazar Chim Golingan;

3. Jamel Erica voluntarily acknowledges that Tracey Nicole is her own daughter
and she desires to have her birth be registered before the Local Civil Registry
of Camiling, Tarlac;

4. However, since Jamel Erica is still a minor, she could not possibly do so
without my parental assistance and concurrence to such intended act;

5. I am executing this affidavit as a manifestation that I gave my parental

guidance and approval to my minor daughter Jamel Erica to acknowledge her
daughter and have such birth be properly recorded before the Local Civil
registry of Camiling, Tarlac;

6. Finally, I am executing this Affidavit to attest to the truth of the foregoing

statements and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6th day of

June, 2017 at Camiling, Tarlac, Philippines.

IMELDA A. VICTORIO
Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated

above. Affiant exhibited before me her Voter ID Card with VIN: 6903-0146A-
F1274IAV20001-1 issued by the COMELEC, Camiling, Tarlac.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2017.