REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

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

AFFIDAVIT OF ILLEGITIMACY

I, MARIA B. DELA CRUZ, of legal age, Filipino, single and a resident of 2222 Washington
Street, Pio del Pilar, Makati City, after having been duly sworn to in accordance with law,
depose and state:

1. That I am a the mother of Juan Dela Cruz who was born in Davao City on October 5, 2006 as
evidenced by the attached Birth Certificate issued by the local civil registrar of Davao City;

2. That my son Juan Dela Cruz was born out of wedlock;

3. That I am not legally married to his father who I no longer have any contact with;

4. That I am executing this affidavit to attest to the above facts and to confirm the illegitimate
status of my child;

5. That I am further executing this affidavit to comply with the regulations of the Philippine
authorities in connection with his travel to Japan and for all legal purposes and intents
beneficial to my child.

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 __________ 20____, in the City of
__________________, by ___________________ with Passport No.________________ issued
on __________________ at _____________.

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