REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CEBU ) S.S.

AFFIDAVIT OF ADMISSION OF PATERNITY AND

TO USE THE SURNAME OF THE FATHER

I, MARIBEL M. CHAVEZ, of legal age, Filipino, single and a resident of Tolosa,

Malabuyoc, Cebu, after having been duly sworn in accordance with law, do hereby
depose and say, T H A T:

1. I am the biological mother of JHON RAYMOND CHAVEZ;

2. JHON RAYMOND CHAVEZ was born on April 11, 2016;

3. The facts of the birth of JHON RAYMOND CHAVEZ were duly registered at the
Office of the Local Civil Registrar of Malabuyoc, Cebu, Philippines under the
following document: Certificate of Live Birth, Registry No. 2016-82, hereto attached
as Annex “A”;

4. At the time of birth of JHON RAYMOND CHAVEZ, I was not married to his father,
RAYMOND DIASANA CARPINA;

5. At the time of the execution of this Affidavit, JHON RAYMOND CHAVEZ is 6 years
old;

6. I am allowing JHON RAYMOND CHAVEZ to use the surname of his father,

CARPINA, to be his surname in his Certificate of Live Birth and all other legal
documents requiring thereof;

7. That finally, I am executing this affidavit for the purpose of informing the authorities
especially the Local Civil Registrar and the Philippine Statistics Authority of the
above-mentioned and for all other legal intents and purposes. This affidavit is based
on personal knowledge.

IN WITNESS WHEREOF, I hereby affix my signatures, this September 3, 2022 at

Malabuyoc, Cebu, Philippines.

MARIBEL M. CHAVEZ
Affiant
Community Tax Cert. No. CCI2021 09634619

SUBSCRIBED AND SWORN to before me on September 3, 2022 at Malabuyoc,

Cebu, Philippines.. Affiant exhibited to me her competent proof of identification as
indicated above.

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Series of 2022.