REPUBLIC OF THE PHILIPPINES )

PROVINCE OF DINAGAT ISLANDS )S. S

MUNICIPALITY OF SAN JOSE )

AFFIDAVIT OF ACKNOWLEDGEMENT, SUPPORT &

USE OF LAST NAME

I, ANTHONY S. ECLEO, of legal age, single, Filipino Citizen, and a resident of

Brgy. Jacquez, Municipality of San Jose, Province of Dinagat Islands, after having been
duly sworn to in accordance with law do hereby, depose and say THAT:

I am the natural father of PRINCESS ATHENA BENSURTO ECLEO who was

born on December 19, 2012 at the Rural Health Unit of Brgy. Don Ruben, Municipality
of San Jose, Province of Dinagat Islands ;

As the natural father of PRINCESS ATHENA BENSURTO ECLEO, I

undertake to give her through her mother RACHEL ANNE V. BENSURTO, financial
support in the amount which will be agreed upon in a separate document;

I am also giving my express consent to PRINCESS ATHENA BENSURTO

ECLEO to use my last name and such fact to be registered in the Local Civil Registry;

I am executing this affidavit to attest the veracity of the foregoing and for
whatever purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of August
2013 at the Municipality of San Jose, Province of Dinagat Islands, Philippines.

ANTHONY S. ECLEO
Affiant

SUBSCRIBED AND SWORN, to before me this 2nd day of August 2013 at the
Municipality of San Jose, Province of Dinagat Islands, Philippines