Republic of the Philippines ]

Calamba City, Laguna ] s.s.

AFFIDAVIT OF CORRECTION OF ENTRY

IN CERTIFICATE OF LIVE BIRTH OF MINOR CHILD
I, ERMELISA BASILLOTE TANIO-FLORES, of legal age, Filipino, married and
with residence address at Miniano Compound (near Checkpoint), Brgy. Paciano
Rizal, Calamba City 4027 Laguna after having been sworn in accordance with
law, hereby depose and state that –
1. I hereby state under oath that there is a clerical error in the name of my
son (born on 02 April 2020) in his Certificate of Live Birth appearing
therein as “MC FLORES MATOZA”, as shown in Entry No. 1 – Name of
Child.
2. The clerical error is the typewritten entry of the middle name: “FLORES”.
The correct middle name should have been “TANIO” instead of “FLORES”
because my correct maiden name is “ERMELISA BASILLOTE TANIO”, and
not the wrong one appearing on Entry No. 7 which was erroneously
typewritten as “ERMELISA TANIO FLORES”.
3. The correct full name of my son who was born on 02 April 2020 therefore
should have been “MC TANIO MATOZA”; his father being “MARIO
MARGATE MATOZA”; and my maiden surname being “TANIO”.
4. Hence, for all intents and purposes, the clerical error in the typewritten
Entry No. 1 of the said certificate of live birth appearing as “MC FLORES
MATOZA” should be corrected to “MC TANIO MATOZA”.
5. I executed this affidavit for the correction of entry in the said birth record;
to attest to the truth of the foregoing statements; and for any other
lawful purposes this may serve.
IN WITNESS WHEREFORE, I hereto affixed my signature this 14 November
2022 at Calamba City, Philippines, Laguna.

ERMELISA BASILLOTE TANIO-FLORES

Affiant
SUBSCRIBED AND SWORN to before me by the affiant who exhibited to me
her Voter’s ID No. 2251-0010B-F2086ETF20000.
WITNESS MY HAND AND NOTARIAL SEAL this 14 November 2022 at
Calamba City, Laguna, Philippines.

Doc. No. ________; ATTY. EMMANUEL E. SANDICHO

Page No. ________;
Book No. ________;
Series of 2022.
NOTARY PUBLIC UNTIL 31 DECEMBER 2022
NOTARIAL COMMISSION NO. 19-2021-C
IBP O.R. No. 169038, 01 Jan. 2022, Laguna Chapter
PTR O.R. No. CC7894982, 04 Jan. 2022, Calamba City
Roll No. 42246, admitted to the Phil. Bar on 9 May 1997
MCLE Compliance Cert. No. VII-00020029 Until 14 April 2025
2ND Floor HK Building, National Highway-MSR, Brgy. Halang
Calamba City 4027 Laguna CALABARZON Philippines