Republic of the Philippines)

)
)…s.s

AFFIDAVIT OF CONFIRMATION

I, _______________________________________, a Filipino of legal age, a resident of

_______________________________________________ a bona fide member of the
Philippine National Police with the rank of _____ and presently assigned at ________ 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 heirs, to wit:

NAME RELATIONSHIP BIRTHDATE

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

2. My relationship with 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 Philippine Statistics Authority; and

4. I hold myself criminally 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:

________________________
Affiant
Contact No: ______________

SUBSCRIBED AND SWORN to before me this _____ day of ___________________ at

___________________________ Philippines.

Doc No. __________________

Page No. __________________
Book No. __________________
Series No. __________________