REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

TABACO CITY )
x------------------------------------------x

AFFIDAVIT OF MOTHER

I, ___________________________________, of legal age, Filipino, _________ and a

resident of _______________________ ____________, after having been duly sworn
to in accordance with law, depose and state:
1. That I am the LEGITIMATE mother of RYAN SANTOS who was born last June
25, 2013 in Tacloban City;
2. That I am very much willing to allow my child RYAN SANTOS to use the
surname of the father for whatever legal purpose his birth be used;
3. That I am executing this affidavit to attest to the truth of the following facts in
accordance with RA 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________
20____ in ____________, _____________, Philippines.

___________________________________

Affiant

Voter's ID No. ______________________

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at

________________ affiant exhibited to his/her competent evidence of identity by way of
_________________ issued on __________________ in _______________,
Philippines.

ATTY. ANTHONY CLARK A. GAPIDO

Notary Public Tabaco City
For the Province of Albay
Roll No. 83746
IBP OR No. 227570; June 13, 2022
PTR No. 8843533; July 13, 2022 at Tabaco City
MCLE: N/A (Newly Admitted to the Bar)
2nd Floor Coastal Building Rental, Purok 2,
Morales Street, San Roque,Tabaco City, 4511

Doc No.____;
Page No. 450;
Book No. 35 ;
Series of 2022