REPUBLIC OF THE PHILIPPINES )

CITY OF MANDALUYONG )S.S.

x -x

AFFIDAVIT
I, CHENALYN BACAY, Filipino of legal age, with residence address at Blk 46 Lot 16
Phase 3 E 2 Longos Malabon, after having been sworn to in accordance with law, do hereby
depose and say that:

1. I am the daughter of Fernando Datingaling Bacay and was born on April 01, 1987 in
the City of Navotas as evidenced by my Philippine Identification Card.

2. My name indicated in the Certificate of Death of my father is “CHENALAYN

BACAY”;

3. I have been using the name of CHENALYN BACAY in all my records as evidenced
by my Philippine Identification Card hereto attached as Annex “A”,

4. The error/ discrepancy may have been due to clerk/personnel who prepared the
Certificate of Death of my father who erroneously wrote my name as Chenalayn
Bacay;

5. CHENALYN BACAY and CHENALAYN BACAY is one and the same person;

6. I attest to the truth and veracity of the statements herein stated;

7. I am executing this affidavit for passport replacement and for all legal intents and
purposes;

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ______ 2023 at
Mandaluyong City.

CHENALYN BACAY
Affiant

SUBSCRIBED AND SWORN to before me on this _____ day of ______ 2023

___________________, Philippines, affiant presenting to me her Philippine Identification Card
3541-2732-5048-6921 issued on November 18, 2021.

Doc. No. ____;

Page No. ____;
Book No. _____;
Series of 2023.