REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF CONFIRMATION

I, GLENN VILLOTA SEMBRANO, a Filipin, of legal age, a resident of #417 Toledo Tower Tropicana
Garden City Sumulong Hi-way Sto.Niño Marikina City , a bona fide member of the Philippine National
Police with the rank of PLTCOL and presently assigned at Camp BGen Rafael T Crame, Quezon City after
having been duly sworn to in accordance with the law, do hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal beneficiaries and/or
heirs, to wit:

NAME RELATIONSHIP BIRTHDATE

Rosalynn T. Sembrano Wife March 06, 1980
Amiel Mario C. Sembrano Son September 03, 1995
Eliora Pauline C. Sembrano Daughter April 22, 1999
Carla Patrice T. Sembrano Daughter December 03, 2011
Mia Lorraine T. Sembrano Daughter December 03, 2011

2. My relationship with this persons whose names are listed above are borne out by the fact that I
am the lawful spouse and the father/mother of the afore-named children as evidenced by the
attached advisory on marriages, marriage contract and birth certificates;
3. That all the documents I have attached and submitted to support the updating of my DLB are
original copies obtained from the Philippine Statistics Authority; and
4. I hold myself criminality and administratively liable for perjury and dishonesty should any
statements made herein/documents submitted herewith are inaccurate or later found to be
false and in violation of law.

AFFIANT SAYETH NAUGHT:

GLENN VILLOTA SEMBRANO

Affiant

SUBSCRIBED AND SWORN to before me this___________________ affiant exhibiting to me his/ her

CTC No. __________________ issued on ______________ at _____________ Philippines.

Doc No. ________

Page No. ________
Book No. ________ Notary public
Series of 2019