Republic of the Philippines )

City of Cagayan de Oro ) S.S.

AFFIDAVIT OF NON-EMPLOYMENT

I, LUCIA A. SIA ACHACOSO, of legal age, married, Filipino,

and a resident of Zone 1, Estakahan, Agusan, Cagayan de Oro City,
after having been duly sworn to in accordance with law, do hereby
depose and say:

1. That I have been using the name LUCIA A. SIA since time
immemorial, per Certification issued by the Office of the
Civil Registrar, Manolo Fortich, Bukidnon dated June 24,
1945.
2. That sometime in 2001, I learned that my name actually
appears as LUCIA SINATRA SIA, per Certification issued by
the Office of the Civil Registrar, Manolo Fortich, Bukidnon
dated September 6, 2001.
3. That I have decided to comply with Change of First Name
requirements.
4. That I am not gainfully employed by any public institution
or private entity nor do I have any other source of income.
5. That I execute this affidavit as to the truth of the foregoing
facts and for whatever legal purpose/s this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 5th day of October, 2018, in the City of Cagayan de Oro,
Philippines.

LUCIA A. SIA
ACHACOSO
Affiant
VIN: 4305-0127A-
L1360LSA20003-0

SUBSCRIBED AND SWORN TO before me this 5th day of

October, 2018 in the City of Cagayan de Oro, Philippines.

Doc No.
Page No.
Book No.
Series of 2018.