Republic of the Philippines)

)
)…s.s.

AFFIDAVIT OF CONFIRMATION

I, JACKY OLIVER FERNANDEZ ABAD, a Filipino of legal age, a resident of 065

ALERTA STREET, BARANGAY DADIANGAS NORTH, GENENRAL SANTOS CITY, a
bona fide member of the Philippine National Police with the rank of Patrolman and presently
assigned at RPSMD, PRO 12 after having been duly sworn to in accordance with law, do
hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal

beneficiary/ies and/or heir/s, to wit:

NAME RELATIONSHIP BIRTHDATE

REYNALDO CANJA ABAD FATHER OCT 20, 1964
ROWENA TAGUPA FERNANDEZ MOTHER SEP 03, 19

2. My relationship with person/s whose name/s is/are listed above is/are borne out by
the fact that I am the lawful father/mother of the afore-mentioned child/children as
evidenced by the attached cenomar and birth certificate/s;

3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiary/ies are original copies obtained from Philippine Statistic
Authority (PSA); and

4. I hold myself criminally and administratively liable for perjury and dishonesty should
any statements made herein/documents submitted herewith are inaccurate or later
found to be false and in violation of law.

AFFIANT SAYETH NAUGHT:

_____________________________
Affiant
Contact No. ___________________

SUBSCRIBED AND SWORN to before me this ____________ day of ________________ at

___________________________________, Philippines

Doc. No. ___________

Page No. ___________
Book No. ___________
Series No. ___________