Republic of the Philippines)

Province of Agusan del Sur) S.S

MUNICIPALITY OF ___________)
X - - - - - - - - - - - - - - - - - - - - - /

AFFIDAVIT OF LEGITIMATION

That we, ________ and ___________, both of legal age,

Filipino citizens, married couple and presently residing at
P_________________-, Agusan del Sur, Philippines, after having
been duly sworn to oath in accordance with law, do hereby depose
and say:

That we are the same persons executing this affidavit;

That we are the parents ______________ , who was born on MAY

2,2003 at _____________, ___________ ,Agusan del Sur,
Philippines;;

That during the conception of the above-mentioned child, we

were not disqualified by any impediment to contract marriage and
in fact we were legally married on August 9, 2003 and the
marriage ceremony was officiated by REV.FR._______________. at
San Juan Catholic Chapel ,__________________ ;

That we are executing this affidavit to establish the

truthfulness of the foregoing statements; and

AFFIANTS SAYETH NONE.

IN WITNESS WHEREOF, we have hereunto set our hands this 1 st

day of September, 2015 in ___________, Agusan del Sur,
Philippines.

(Affiant) (Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME this 1st day of September,

2015 in ___________, Agusan del Sur, Philippines.