REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NEGROS ORIENTAL) S.S.

CITY OF DUMAGUETE......................)

JOINT AFFIDAVIT

We, ___________________, Filipino, of legal age, married with

residence and postal address at Brgy. Calindagan, Dumaguete City and
_____________, single, Filipino, of legal age with residence and postal
address at Tubtubon, Sibulan, Negros Oriental, Philippines, after having
been duly sworn to in accordance with law, do hereby depose and state:

1. That we personally know the person of TOMASA ANNE KATADA

DOMINGO being the daughter of VAN ZAMORA DOMINGO;

2. That as per records of Philippine Statistics Authority, her first name was
entered as THERESA ANNE. However, in the records of her Baptismal
Certificate her first name was erroneously entered as, TOMASA ANNE;

3. That one TOMASA ANNE KATADA DOMINGO and THERESA ANNE

KATADA DOMINGO refers to one and the same person;

4. That her true and correct first name is TOMASA ANNE as shown by her
Birth Certificate and Philippine Passport;

5. That we are executing this Affidavit to attest to the truth of the foregoing
statement of fact, to support the claim of TOMASA ANNE KATADA
DOMINGO for whatever purposes it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 TH day

of April 2017 in Dumaguete City, Philippines.

Affiant Affiant
ID No. ______________________ ID No. ___________________

JURAT

SUBSCRIBED AND SWORN to before me this 28 th day of March

2017 in Dumaguete City, Philippines.

Doc. No. __;

Page No. __;
Book No. __;
Series of 2017.