REPUBLIC OF THE PHILIPPINES)

)
)…s.s.

AFFIDAVIT OF CONFIRMATION

I, JR CAPURAS CAÑETE, a Filipino of legal age, a resident of SITIO BATOBATO BRGY

TABUN-AC, TOBOSO, NEGROS OCCIDENTAL, a bona fide member of Philippine National Police
with the position of PATROLMAN and presently assigned at Information Technology
Management Service (ITMS) after having been duly sworn to in accordance of law, do hereby
depose and says that;

1. Pursuant to this affidavit, I am confirming that the name hereunder is my legal

beneficiary and/or heir to wit:

NAME RELATIONSHIP BIRTHDATE

ANA FE CAPURAS CAÑETE MOTHER FEBRUARY 18, 1967

My relationship with the person whose name listed above is borne out by the fact that I
am the lawful son of the afore-named person as evidence by the attached advisory on birth
certificates;

2. That all the documents I have attached and submitted to support the updating of my
DLB are original copies obtained from the Philippine Statistics Authority; and

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

AFFIANT SAYETH NAUGHT.

____________________
Affiant

Contact No: 09460443927

SUBSCRIBE AND SWORN to before me this _____________ day of ____________ at

__________________ Philippines.

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