REPUBLIC OF THE PHILIPPINES)

) SS.
DONE: IN THE CITY OF )

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, DDD, of legal age, Filipino, married, a resident of CNDO., FABELLA ST.,
MANDALUYONG, after having been duly sworn to in accordance with law, hereby depose
and state:

1. That when my parents enrolled me for my formal education, they registered,

supplied and entered “DDD” as my appellation with DDD being my first name;

2. That in all my private and public transactions I entered into, I supplied and
entered “DDD” as my WHOLE NAME because in truth and in fact, it is my given
name;

3. That when I secured my Certificate of Live Birth from the National Statistics
Office, I discovered that my name entered and registered was BABY BOY,
however, my true and real name DDD was correctly registered and entered with
the Local Civil Registrar of Baguio City;

4. That the names BABY BOY appearing in the Certificate of Live Birth registered
with the National Statistics Office, and the name DDD appearing in my Certificate
of Live Birth registered with the Local Civil Registrar of Baguio City, refer to me
and to me alone;

5. That the erroneous registry of my FIRST NAME in my Certificate of Live Birth

was due to inadvertence and did not arise from any malevolence or done to hide
my identity or to defraud any third party;

6. That I am executing Affidavit to attest to the truthfulness of the foregoing and

for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this day of January,

in the City of Baguio, Philippines.

DDD
Affiant

SUBSCRIBED AND SWORN TO before me this 19th day of January, 2015 in the City
of Baguio, Philippines.