Republic of the Philippines )

PROVINCE OF CAGAYAN ) Sc.

Tuguegarao City )

AFFIDAVIT OF IDENTITY
I, MARIA DELA CRUZ, of legal age, married, Filipino and a resident of
Wonderland Subdivision, Sta. Teresa, Iguig, Cagayan, states that:
1. I am the mother of Mario S. Dela Cruz.
2. My son, however, was baptized as Marlown S. Dela Cruz on the
mistaken belief that he was registered as Marlown S. Dela Cruz in his Certificate of
Live Birth.
3. It was only after the marriage and birth of my sons daughter, Kaycee
Anne Tica Dela Cruz, that we learned after securing a copy of my sons birth
certificate that his registered name is actually Mario and not Marlown as he has
been using.
4. After discovering that my sons registered name is Mario instead of
Marlown, my son opted to use his registered name.
5. Unfortunately, during the birth of Kaycee Anne Tica Oliga and his
declaration as a dependent on my sons PhilHealth application, he has not yet
discovered his registered name and hence indicated his name in his application form
as Marlown instead of his registered name as Mario.
6. I hereby attest that Mario S. Dela Cruz is one and the same person as
Marlown S. Dela Cruz.
7. My son, Mario S. Dela Cruz, as well as his wife, Maricel Dela Cruz,
are all working as overseas Filipino workers in Saudi Arabia.
8. I have been charged as the guardian of the children of Mario and
Maricel Dela Cruz.
9. Presently, Kaycee Anne Tica Dela Cruz is confined at St. Paul
Hospital and is due for surgery.
10. I execute the foregoing Affidavit to support the application for health
insurance benefits of Kaycee Anne Dela Cruz as a dependent of Mario S. Dela Cruz
with the PhilHealth in connection with her medical confinement.
11. I attest to the truth of the foregoing.
IN WITNESS WHEREOF, I affix my signature this ___ day of March 2014 at Tuguegarao
City, Cagayan.

EUFEMIA S. DELA CRUZ
Affiant

JURAT


SUBSCRIBED AND SWORN to before me this ___ day of March, 2014 at
Tuguegarao City, Cagayan.