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Republic of the Philippines)

Lamut )
Ifugao Province ) . . .s.s

AFFIDAVIT OF CONFIRMATION

I, _____________________, a Filipino of legal age, a resident


_____________________________a bonafide member of the Philippine National
Police with rank of and presently assigned at ___________________________after
having been duly sworn to in accordance with law, do hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal


Beneficiaries and/or heirs, to wit:

NAME RELATIONSHIP BIRTH DATE

2. My relationships with persons whose names are listed above are borne
out by the fact that I am the lawful son and as evidence by the attached
advisory on birth certificates.

3. That all documents I have attached and submitted to support the updating
of my DLB are original copies obtained from Philippine Statistic Authority;
and

4. I hold myself criminally and administratively liable to perjury and


dishonesty should any statements made herein/documents submitted
herewith are inaccurate or later found to be false and in violation of law.

AFFIANT SAYETH NAUGHT:

Affiant

Contact No: 09672915907

SUBSCRIBED AND SWORN to before me this ______ day of _______________ at


_______________________________, Philippines.

Doc No. ______


Page No. ______
Book No. ______
Series No. ______

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