REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS, ILOCOS NORTE )SS.

JOINT AFFIDAVIT OF DISINTERESTED PERSONS

We, ________________________and __________________________, of legal age, Filipinos and

residents of ___________________________________San Nicolas Ilocos Norte, Philippines under oath
depose and state that:

1. We personally and intimately know AVEGAIL BONETH AGAG URBANO who was born to
Elpidio P. Urbano and Girlie G. Agag on July 7, 1987 in Barangay 7, San Nicolas Ilocos Norte;

2. We know that Avegail Boneth Agag Urbanois naturally born and is publicly known as female;

3. We know of the foregoing facts as we were then present when Lolita was born in San Nicolas,
Ilocos Norte;

4. We are not related to said Avegail Boneth Agag Urbano by affinity nor consanguinity;

5. We are therefore executing this affidavit to attest to the truthfulness and veracity of the
foregoing and to attest that AVEGAIL BONETH AGAG URBANO who was born on July 7, 1987
in ___________________ San Nicolas Ilocos Norte is a naturally born as female and not male
as erroneously indicated in her Certificate of Live Birth;

6. This joint affidavit is made for whatever legal purposes it may serve.

IN WITNESS HEREOF, we have hereunto set our hands this 22nd day of February 2018 at San
Nicolas Ilocos Norte, Philippines.

____________________________ __________________________
Affiant Affiant

SUBSCRIBED AND SWORN TO before me this____ day of _____________ at San Nicolas,

Ilocos Norte. The contents of this affidavit were translated and explained in Iloco to the Affiants,
the language understood by them.

Doc. No. _________;

Page No. _________;
Book No _________:
Series of 2018.