REPUBLIC OF THE PHILIPPINES )

Province of Nueva Ecija ) S.S.

Science City of Munoz )

AFFIDAVIT OF FACTS OF BIRTH

I, MA. ELENA AGOY SARMIENTO-BALBARONA, of legal age,

married, Filipino, presently residing at Barangay Bantug, Science City of
Muñoz, Nueva Ecija, after having been sworn to in accordance with law,
hereby depose and state, THAT:

1. I am the daughter of SPOUSES ROGELIO SARMIENTO

and ERLINDA B. AGOY.

2. I was born on July 29, 1976 in Barangay Pob. West,

Science City of Muñoz, Nueva Ecija.

3. My parents failed to register my birth, hence, my desire to

cause the late registration of it with the Local Civil Registrar
of the Science City of Muñoz, Nueva Ecija, the place where
I was born.

4. I have executed this affidavit to attest to the truthfulness of

the foregoing facts, for the late registration of my birth or
any remedy that may be available for me regarding my birth
certificate or for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

December 28, 2020 at Science City of Munoz, Nueva Ecija.

MA. ELENA AGOY SARMIENTO-BALBARONA

Affiant
CTC No. 16416381
Issued at: Science City of Muñoz, Nueva Ecija

SUBSBRIBED and SWORN to before me this December 28 2020 at

Science City of Muñoz, Nueva Ecija and I hereby certify that the affiant has
read the contents of her affidavit and understands the same.

Doc. No.: 432;

Page No.: 88;
Book No.: VIII;
Series of 2020.