Republic of the Philippines )

City of Caloocan ) S.S.

x--------------------------x

AFFIDAVIT TO USE THE SURNAME OF THE

FATHER/ACKNOWLEDGMENT
I, ARIEL BUSTOS CURA, of legal age, Filipino citizen, and
presently residing at Purok 3, Solib, 16 Floridablanca, Pampanga, after
having been duly sworn to in accordance with law, do hereby depose
and say:

1. That I am the biological father of ARRYL JAY GUMBA.

2. That the biological mother of the child is JOSEPHINE

GUMBA.

3. That my child ARRYL JAY GUMBA was born on January

7, 2000 at the City of Manila.

4. That the facts of birth of my child were duly registered at

the Office of the Manila City Civil Registrar.

5. That I, ARIEL BUSTOS CURA being the father of ARRYL

JAY CURA, hereby acknowledged and recognized him as my
child and legal heir.

6. That I am allowing my child ARRYL JAY GUMBA to use

my surname CURA to be his surname in his Certificate of Live
Birth, Marriage Contract and other legal documents.

7. That I execute this affidavit to attest to the truth of the

above facts in compliance with the provisions of Republic Act
No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day

of June 2023 at Caloocan City, Metro Manila, Philippines.

ARIEL BUSTOS CURA

Affiant

SUBSCRIBED AND SWORN to before me this 7th day of June

2023 in the City of Caloocan, Metro Manila, Philippines, affiant exhibiting
to me his competent evidence of identity by way of Social Security
Identification Card No. 33-3867320-3.
NOTARY PUBLIC
Doc No. _____;
Page No. _____;
Book No._____;
Series of 2023