Republic of the Philippines )

Province of Lanao del Norte ) S.S.

Municipality of Tubod )
x----------------------------------/

AFFIDAVIT
I, MUGIWARA, of legal age, Filipino, single, and a resident of Quezon City, after having
been duly sworn to in accordance with law, do hereby depose and state:

1. That I was born on January 13, 1993 at Quezon City;

2. That when I secured a NSO copy of my Certificate of Live Birth, I found out that the
entry of my sex/gender was erroneously indicated as Male when in truth and in fact I am a Female;

3. That since birth, my natural and biological gender has always been FEMALE and that I
am identified as a female by my family, friends, acquaintances and by the community;

4. That I am executing this Affidavit to attest to truth and veracity of the foregoing
declarations and for whatever legal purpose(s) this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this _____________,

in Quezon City, Philippines.

MUGIWARA
Affiant

SUBSCRIBED AND SWORN to before me on this _________________, in Quezon City,

Philippines by the Affiant with competent proof of identity, xxx, with which I ascertained her true
identity and person, and affirmed the verity of her foregoing statements.

NOTARY PUBLIC