REPUBLIC OF THE PHILIPPINES

PROVINCE OF CAGAYAN
MUNICIPALITY OF AARRI

)
) S.S.
)

AFFIDAVIT
I, JENNIFER CABATIC DUMLAO, of legal age, Filipino, single and
resident of Maura, Aparri, Cagayan, Philippines, under oath depose and say
that:
1. That I was born on November 8, 1985 at Maura, Aparri, Cagayan
and a Certificate of Live Birth was registered with the Local Civil
Registrar of Aparri, Cagayan on November 11, 1985;
2. That when I secured a NSO copy of my Certificate of Live Birth, I
found out that the entry for my Sex/Gender was erroneously
indicated as FEMALE, when in truth and in fact, I am a MALE; and
3. That I am executing this affidavit to attest the truth of the foregoing,
for the purpose of securing of medical certificate and passport and
for whatever legal purpose it may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of
March 2016 at Aparri, Cagayan.

JENNIFER CABATIC
DUMLAO
Affiant
Voters ID K0885JCD10000
Issued at Aparri, Cagayan
SUBSCRIBED AND SWORN to before me, this 9 th day of March 2016, in
the Municipality of Aparri by affiant identified through his competent
evidence of identity.

Doc. No. ____;

Page No. ____;
Book No. ____;

ERNANI T. TADILI
NOTARY PUBLIC
Until December 31, 2016

Series of 2016.

IBP OR No. 946905

PTR OR No. 6485838
Attorneys Roll No. 64233