REPUBLIC OF THE PHILIPPINES)

City of Baguio) S.S.

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, of legal age, Filipino, and residing/with postal address at, under oath, state that:

1. I am an applicant for the processing of the Supplemental Report of:

My Certificate of Live Birth registered in Manila;

2. The original copy of my Certificate of Live Birth was forwarded to the Philippine
Statistics Authority (PSA);
3. When a copy of my Certificate of Live Birth was secured from PSA Baguio City, it was
discovered that there is no entry under the following item: FIRST NAME and the suffix
“JR.”;
4. There was a failure to supply the said item due to the inadvertence of the registrant;
5. The entries to be indicated should be the following: JR.;
6. I am requesting the concerned authorities to supply the omitted information in my
Certificate of Live Birth;
7. I am executing this Affidavit to attest to the truth of the foregoing facts and to use the
same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this day of March 2022

in Baguio City, Philippines.

Affiant

SUBSCRIBED and SWORN to before me this day of March 2022. Affiant

exhibiting to me his as his competent proof of identity.

Doc No.:
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Series of 2022.