Republic of the Philippines)

)
) . . .s.s.

AFFIDAVIT OF CONFIRMATION/AUTHENTICITY

I, CORA GAY A. MUJAR, a Filipino of legal age, a resident of #409 WEST

WASHINGTON DRIVE, LEGAZPI CITY, a bona fide member of Philippine National Police as a
Non-Uniformed Personnel with position as Administrative Assistant 1(Computer Operator 1) and
presently assigned at Regional Internal Affairs Service 5 after having been duly sworn to in
accordance with law, do hereby depose and says that:

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

NAME RELATIONSHIP BIRTH DATE

JOSE ROSEL A. MUJAR HUSBAND May 11, 1979
JOE ANDREI A. MUJAR SON April 7, 2009
GAEA FRANCOIS A. MUJAR DAUGHTER August 22, 2012
YSOBEL GAYLE A. MUJAR DAUGHTER November 27, 2018

2. My relationship with persons whose names are listed above are borne out by the fact that I
am the lawful spouse and the legitimate mother of the afore-named children as evidenced by
the attached advisory on marriages, marriage contract and birth certificates:

3. That, all the original copies of the documents I have attached and submitted hereto to support
the updating of my DLB are genuine and authentic; and

4. I hold myself criminally and administratively liable for perjury and dishonesty should
any statements made herein are inaccurate or alter found to be false and in of law.

AFFIANT SAYETH NAUGHT:

______________________________
Affiant

Contact No: ____________________

SUBSCRIBED AND SWORN to before me this___ day of ______________________ at

______________________________________ Philippines.

Doc No. ___________

Page No. ___________
Book No. ___________
Series No, ___________