REPUBLIC OF THE PHILIPPINES)

Province of Camarines Sur) S.S.

City of Naga)
x-----------------------x

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, RODERICK E. BRAVO, of legal age, Filipino, and presently residing at Abella,

Naga City after having been duly sworn to in accordance with law, do hereby depose and
say:

1. That I am the biological father of CEDRICK JAMES AGAWA;

2. That the biological mother of the child is JULIE C. AGAWA;

3. That our child was born on October 15, 2014 at Bicol Medical Center, Naga City;

4. That I, RODERICK E. BRAVO being the father of CEDRICK JAMES AGAWA,

hereby acknowledged and recognized him as my child and legal heir;

6. That I am allowing my child CEDRICK JAMES AGAWA to use

my surname BRAVO to be his surname in his Certificate of Live Birth and such
other documents as may be applicable; and

7. That I execute this affidavit to attest to the truth of the above facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at

Naga City, Philippines.

RODERICK E. BRAVO
Affiant

SUBSCRIBED AND SWORN to before me this _________ in the City of Naga,

Philippines, affiant exhibiting to me his competent evidence of identity by way of his
PhilHealth No: 05-050074193-4.

Doc No. : _____

Page No.: ______
Book No.: ______
Series of 2015 Notary
Public