REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.

SWORN STATEMENT

I ROSEMELINDA B. LAPATING, of legal age and a resident of Blk 5, Lot 11,

White Duck St., Rainbow Homes I, San Bartolome, Novaliches, Quezon City after
having been sworn under oath , do hereby depose and state that:

1. That I am Rosemelinda Bucoy Lapating, born on March 19, 1979 to

her parents—Rosalinda Bucoy and Benjamin Bucoy at Liguian, Tungawan,
Zamboanga del Sur

2. That I requested for a renewal of passport with the Department of

Foreign Affaiars. However, there appears a discrepancy in the records. To
correct the said discreoancy, I was made to secure a certificate of no record of
the name Lara Simbulas Bucoy at the Local Civil Registrar of Roseller,
Zamboanga Del Sur.

3. That when I requested for the said certification, I was told that
Roseller did not have a Local Civil Regisrar at that time. The registration are filed
with Local Civil Registrar of Tingian, Zamboanga del Sur. So I went to Tingian
Zamboanga del Sur to secure the said certification. However, the Local Civil
Registrar released the same Birth Certificate as that for Rosemelinda B. Lapating.
They said they cannot issued a negative certification because, once requested, a
certificate appears but that of Rosemelinda B. Lapating.

4. It appears that the record at Roseller, Zamboanga del Sur, is the

same certificate of Rosemelinda Lapating, the identity is the same.

5. That I am executing this sworn statement to attest to the veracity

of the foregoing and in support of my request to rectify my records with the
Department of Foreign Affairs and for the proper authorities to issue me a new
passport already in my name.

IN WITNESS WHEREOF, I have affixed my signature, this __ day of

February, 2022 at Quezon City.

Rosemelinda B. Lapating
Affiant

Subscribed and sworn to before me this ___th day of February 2022 in Quezon
City. Affiant exhibited to me her Drivers License card No. _____________ and
she affirmed that she read, understood and voluntarily executed her testimony
as witness.
Notary Public
Doc. No. ____
Page No.____
Book No. ____
Series of 2022