Republic of the Philippines )

City/Municipality of ____________ )S.s.

x-------------------------------------------------/

AFFIDAVIT OF UNEMPLOYMENT

I, ROSINE A. TAPALES, of legal age, Filipino, single, and a resident

of Brgy. Basdiot, Moalboal, Cebu, after having been sworn to in accordance
with law, state that:

1. I am currently not employed by any person, company or corporation;

2. I am living with my common law husband and being supported by
him;
3. I am executing this affidavit to attest to the truth of the above-stated
statements;
4. I am also executing this affidavit to support my Petition for
Correction of Clerical Error in my Certificate of Live Birth as proof
that I have no pending administrative, civil, or criminal case with an
employer since I am not employed with any person.

IN WITNESS WHEREOF, I have affixed my signature this ___ day

of ________________ 2019 at ________________, Philippines.

ROSINE A. TAPALES
Affiant

SUBSCRIBED AND SWORN to before me this __ day of

__________________ 2019 at ______________________________, petitioner
exhibited to me her VIN: 2233-0033B-L2482RAT20000 as proof of identity.

Doc No.: ;
Page No.: ;
Book No.: ;
Series of 2019.