Republic of the Philippines )

CITY OF TACLOBAN . . . .) ss.

x---------------x

AFFIDAVIT of CONSENT

I, MARICEL REGALA LINDE, Filipino, of legal age, single and a resident of Brgy.
Guindapunan, Palo, Leyte, Philippines, under oath declares:

1. That I am seeking to change my surname in my Certificate of Live Birth;

2. That I was born on 20 December 1982 at Tacloban City, Leyte to spouses ROGELIO
PARADO LINDE and LOLITA REGALA LINDE whose marriage was solemnized on
March 16, 1988;

3. My birth was registered with the Office of the Civil Registrar, Tacloban City. However in
their records, my Last Name was indicated as “REGALA”;

4. That my birth was recorded under Registry No, _____________ at the Local Civil
Registry of Tacloban City;

5. That the surname to be changed is from “REGALA” to “LINDE” pursuant to

Republic Act 9255;

6. That in my other pertinent documents and records, I am already using the name
“MARICEL REGALA LINDE”;

7. That I am willing and giving my consent to use the Surname of my father “LINDE” in my
Certificate of Live Birth;

8. Finally I am executing this affidavit to attest to the truth and veracity of all the foregoing
facts, and to change my surname as “LINDE” in my Certificate of Live Birth with the
Office of the Civil Registrar of Tacloban City.

IN WITNESS WHEREOF, we have hereunto set my hand this 3rd day of May 2019 in
Tacloban City, Philippines.

MARICEL REGALA LINDE

Affiant
VIN: 3739-0076A-L2082MRL20000
Issued by COMELEC

SUBSCRIBED AND SWORN to before me this 3rd day of May 2019 in Tacloban City,
Philippines.

Doc. No.___
Page No.___
Book No.___
Series of 2019.