Republic of the Philippines)

)
) …s .s.

AFFIDAVIT OF CONFIRMATION

I, _______________________________________________, a Filipino, of legal age, a resident

of ________________________________________________ a bona fide member of the Philippine
National Police with the rank of _____and presently assigned at _____ after having been duly
sworn to in accordance with law, do hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal beneficiaries
and/or heirs, to with:

NAME RELATIONSHIP BIRTHDATE

2. My relationship with persons whose names are listed above are borne out by the fact
that
I am the lawful father/mother of the afore-named children as evidenced by the Birth Certificates.

3. That all the documents I have attached and submitted to support the updating of my DLB are
original copies obtained from the Philippine Statistics Authority; and

4. I hold myself criminality and administratively liable for perjury and dishonesty should
any
statements made herein/documents herewith are inaccurate or later found to be false and in violation
of law.

AFFIANT SAYETH NAUGHT:

_______________________
Affiant
Contact No: _____________

SUBSCRIBED AND SWORN to before me this ______________ day of ______________ at_____________

Doc No. __________

Page No. _________
Book No. _________
Series No. ________