Republic of the Philippines)

)
)...s.s.

AFFIDAVIT OF CONFIRMATION

I, DAN ROBERT MENDIOLA PEREZ a Filipino of legal age, a resident of BLK. 63,
LOT 120, SAN ROQUE, DAPDAP, BAMBAN, TARLAC, a bona fide member of the
Philippine National Police with the rank of PATROLMAN and presently assigned at
PAMPANGA 2ND PROVINCIAL MOBILE FORCE COMPANY 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 were my legal

beneficiaries and/or heirs, to wit:

NAME RELATIONSHIP BIRTHDATE

Mia Grace Datu Tuazon- Wife September 15, 1996
Perez
Amiro Nad Tuazon Perez Son March 30, 2022

2. My relationship with persons whose names were listed above were borne out by the
fact that I am the lawful spouse and the father of the afore-mentioned child as
evidenced by the attached advisory on marriages, marriage contract and birth
certificate/s;

3. That all the documents I have attached and submitted to support the updating of my
Declared Legal Beneficiaries are original copies obtained from Philippine Statistic
Authority (PSA); and

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

AFFIANT SAYETH NAUGHT:

Pat Dan Robert M Perez

Affiant
Contact No. 09466825513

SUBSCRIBED AND SWORN to before me this ___________ day of ________________ at

___________________________________, Philippines

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