REPUBLIC OF THE PHILIPPINES)

CITY OF BACOLOD) SS.

AFFIDAVIT OF BIRTH

I, PETER SIMON, of legal age, Filipino, married, and presently residing at Brgy.
Bata Bacolod City, Negros Occidental, after having been duly sworn to in
accordance with law, depose and state:

1. I was born on February 15, 1990, in Aguy, Iloilo, to spouses Marc Blazer and
Nikki Benz;

2. This is supported by numerous authentic documents attached in this affidavit; and

I hereby certify that the foregoing statements are correct.

3. I therefore have executed this Affidavit to attest the truth I mentioned herein and
for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of January
2019 in Bacolod City, Negros Occidental, Philippines.

PETER SIMON
Affiant

SUBCRIBED AND SWORN TO before me this 30th day of January 2019 in Imus
City, Cavite, Philippines, affiant exhibiting to me her competent evidence of identity
indicated below his above- stated name.

ATTY. JOSE RAFAEL L. SEGOVIA

Notary Public for City of Bacolod
Appointment No. M-74 until December 31, 2019
Roll No. 96720/IBP Lifetime No. 02831
PTR No. 0128138 January 3, 2019
NOTARY PUBLIC
Doc. No. 53423;
Page No. 68532;
Book No. 85533;

Series of 2019;