REPUBLIC OF THE PHILIPPINES )

PROVINCE OF QUIRINO ) Sc.

MADDELA/NAGTIPUNAN )

AFFIDAVIT

That I, ROVELYN RUIZ-UGAY, of legal age, Filipino citizen, married and a

resident of Dipintin, Maddela, Quirino after having been duly sworn on oath in
accordance with law hereby voluntarily depose and say:

1. That I am the same persons executing the foregoing affidavit and the same
circumstance whom they pertain;

2. That I am the biological mother 0f MENCHIE RUIZ UGAY who was born on
April 30, 1997 at Quirino General Hospital;

3. That at the time she was born, she was registered at the Local Civil
Registrar of Maddela, Quirino. She was born as Female and been using in
all of her pertinent records;

4. That her gender was erroneously and inadvertently entered as MALE in

her Certificate of Live Birth;

5. That I am executing this affidavit to attest to the truthfulness of the

foregoing facts, to correct her gender at her Certificate of Live Birth and to
reflect as FEMALE, not male and for whatever legal purpose it may serve.

IN TRUTH WHEREOF, we have hereunto signed our name below, this

_______________________ at Maddela, Quirino.

ROVELYN RUIZ-UGAY
Affiant
VIN: 5704-0034B-C2576RAU20000

SUBSCRIBED AND SWORN to before me, this _________________________ at

Maddela Quirino..

WITNESS MY HAND AND SEAL

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