REPUBLIC OF THE PHILIPPINES | S. S.

DONE: IN THE CITY OF BAGUIO |

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, GERVAISE MARCIAL TAGUDAR-HIDALGO, of legal age, married,

Filipino citizen, and a resident of Lot 26 Block B, Amethyst Street, Purok 20 NPC
Irisville Subdivision, Irisan, Baguio City, Philippines, after being sworn in
accordance with law, hereby depose and state—

1. I am the daughter of Belino Tadeos Tagudar and Caridad Morales Marcial.

I was born on March 3, 1965 at Baguio General Hospital. The fact of my birth and all
details thereof were duly registered with the Office of the Local Civil Registrar of
Baguio City under Local Civil Registry No. G08

2. That recently, when I secured a copy of my Certificate of Live Birth from

the Philippine Statistics Office-Office of the Civil Registrar General [PSA-OCRG], I
discovered that my first name indicated thereon is “BABY GIRL”. My first name
should be GERVAISE which is the true and correct one.

3. I attest to the truth of the foregoing statements to the best of my own

personal knowledge and based on authentic documents and records. I am executing
this Affidavit in supplying my first name GERVAISE in my Certificate of Live Birth
with the PSA-OCRG copy and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this 19th day of August 2019 at

Baguio City, Philippines.

GERVAISE MARCIAL TAGUDAR-

HIDALGO
Affiant
SSS ID No. 01-0731795-5
VIN:1102-0494A-C0365GTH20001-5

SUBSCRIBED AND SWORN to before me this 19th day of August 2019 at

Baguio City, Philippines.

ATTY. MELISSA L. QUITAN-CORPUZ

Notary Public
Until December 31, 2020
N. A. No. 40-NC-19-R
IBP No. 05109 12.04.2018 for 2019 Baguio City
PTR No. 3884976 12.03.2018 for 2019 Baguio City
Room 202 2/F Otek Business Centre
Doc. No. 305 No. 13 Otek Street, Baguio City 2600
Page No. 51
Book No. XXXII
Series of 2019