REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC
MUNICIPALITY OF LA PAZ ) S.S.

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, APRIL LYN ORPILLA DAGDAGAN of legal age, married, Filipino citizen,

and a resident of Sto. Tomas San Jose City, Nueva Ecija after being duky
accordance with the law depose and say:

1. I was born on April 02, 1985 at La Purisima, La Paz, Tarlac;

2. I am FEMALE;

3. However,it appears from the records of the Office of the Civil Registrar and
Philippine Statistics Authority that I was registered therein without a gender;

4. It is my desire to be registered with the said government offices with the

gender “FEMALE”

5. The failure to state my gender was purely due to the inadvertence of my

parents who failed to notice that my Certificate of Live Birth did not contain
any information as to my gender; and

6. Thus, I execute this affidavit to establish the truth of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have here unto set my hand this 08th day of
November, 2019 in the Municipal of La Paz, Province of Tarlac.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me, this 08th day of November

2019, by APRIL LYN ORPILLA DAGDAGAN, who exhibited to me
(his/her) ID issued by, National Bureau of Investigation ID No. 15219472
issued at Tarlac City, Tarlac Philippines on Oct. 18, 2019

Doc No.: 67
Page No.: 14
Book No.: 1
Series of: 2019