Republic of the Philippines)

City of Roxas ) S.S.

AFFIDAVIT

I, CHONA MARTINO DELA, of legal age, single, Filipino citizen, and a

resident of Sitio Tagubong, Brgy. Bungsuan, Dumarao, Capiz, after being duly sworn in
accordance with law, hereby depose and state that:

1. I was born as CHONA MARTINO DELA born on July 17, 2000 to

Armando Porras Dela and Ma. Vergie Arevalo Martino as shown in the Authenticated
Birth Certificate issued by the National Statistics Office marked as Annex “A”;

2. However, in my Baptismal Register, my name is indicated as CHONA DE

LA and my date of birth is July 7, 2000;

3. I therefore certify that CHONA MARTINO DELA born on JULY 17,

2000 and CHONA DE LA born on July 7, 2000 is one and the same person;

4. Further, I certify that my true and correct name is CHONA MARTINO

DELA born on JULY 17, 2000 as indicated in my birth certificate.

4. I am executing this affidavit for the purpose of affirming the truth of the
foregoing statements and for any legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____day of April at

Bungsuan, Dumarao, Capiz, Philippines.

CHONA MARTINO DELA

Affiant

SUBSCRIBED AND SWORN to before me this _____________ day of

________________________________ in __________________________, Philippines,
affiant exhibiting to me his ____________________________ as proof of his identity.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019