REPUBLIC OF THE PHILIPPINES)

Mandaue City.......................... ) S.S.

AFFIDAVIT

I, BELEN R. ENGHOD, of legal age, single, and with address at Sitio Salvacion, Maguikay,
Mandaue City, after being duly sworn to in accordance with law, do hereby depose and say
that:

1. My name is BELEN RONDON ENGHOG;

2. I was born on February 19, 1986 in Lagundian, Central, Mati, Davao Oriental;

3. The foregoing facts are stated and registered in my birth certificate issued by
the Local Civil Registrar of Mati, Davao Oriental. A copy of my birth certificate
is hereto attached as ANNEX “A”;

4. However, in my Philippine Passport bearing passport no. EB0948053, it was

inadvertently written that my surname is Engnog instead of Enghog;

5. It was also inadvertently written that my date of birth was February 19, 1983
instead of February 19, 1986;

6. Likewise, it was mistakenly written that my place of birth was Pagalungan,

Maguindanao when truth and in fact, I was born in Lagundian, Central, Mati,
Davao Oriental; and

7. I am executing this Affidavit to attest to the truth of the foregoing facts and

to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, i hereunto fix my hand this October 3, 2016 in Mandaue City.

BELEN R. ENGHOD
Affiant

SUBSCRIBED AND SWORN to before me, this October 3, 2016 at Mandaue City, with
affiant showing her government issued ID appearing on the line below her name.

WITNESS MY HAND AND SEAL.

Doc.  No. :  ________;

Page  No. :  ________;
Book No. :  ________;
Series of 2016.