REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN ) S. S.

AFFIDAVIT OPTING TO USE MAIDEN NAME

I, RENE BEB GAMAYON DE LA SERNA, Filipino, of legal age, married and a

resident of J. A. Clarin St., Tagbilaran City, after having been sworn in accordance with law,
hereby depose and say:

1. That I am an applicant for a Philippine Passport;

2. That since my marriage to my husband Arniel Tecson on January 17, 1997, I opted to
continue using my maiden name with the knowledge and consent of my husband;

2. That all my academic records, PRC license and other transactions with the public bears
my maiden name DE LA SERNA;

3. That I execute this affidavit voluntarily to attest to the fact that I opted and is using my
maiden name DE LA SERNA since my marriage until the present and all my records bears the
said maiden name;

4. That Affiant further attest to the truth of the foregoing statements to support my
Philippine Passport and for whatever legal purpose this may serve.

AFFIANT FURTHER SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day, of May, 2005, at
Tagbilaran City, Bohol, Philippines.

RENE BEB GAMAYON DE LA SERNA

Affiant

SUBSCRIBED AND SWORN to before me this ________________, at Tagbilaran City,

Bohol, Philippines, Affiant with her Community Tax Certificate No. 18588853, issued at
Tagbilaran City, on May 18, 2005.

ATTY. THADDEUS JOSE C. ACERO

Notary Public
Doc. No. _______ Until December 31, 20
Page No. _______ Attorney’s Roll No. 23391
Page No. _______ PTR # 1610701, 1-3-05, Valencia, Bohol
Series of 2005 IBP # 546779, 12-2-04, TIN 126-371-455