Republic of the Philippines )

City of Dagupan ) S.S.

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AFFIDAVIT OF THE MOTHER

I, AISA CAYLAN SOTELO, of legal age, Filipino and a resident of

Barangay Balacag, Pozorrubio, Pangasinan, after having been sworn to an oath in
accordance with law depose and say:

1. That I am the legitimate mother of PRINCE ROMEO SOTELO CERA,

who was born last 9 March 2018 in Urdaneta City, Pangasinan.

2. That I am very much willing to allow my child PRINCE ROMEO SOTELO

CERA to use the surname of the father for whatever legal purpose his birth be
used.

3. That I am executing this Affidavit to attest to the truth of the following facts
in accordance with RA No. 9255.

IN WITNESS WHEREOF, I hereunto affix my signature this 21st day of

January 2019 in the City of Dagupan, Philippines.

AISA C. SOTELO
Affiant
Police Clearance No. 38947
Issued on 1/17/2019

SUBSCRIBED AND SWORN to before me this 21st day of January 2019 in

the City of Dagupan, Philippines.

Administering Officer