REPUBLIC OF THE PHILIPPINES]

PROVINCE OF BUKIDNON ] S.S.

CITY OF MALAYBALAY ]

AFFIDAVIT OF ACKNOWLEDGEMENT AND

ADMISSION OF PATERNITY

I, IGNACIO R. PANONCIAL, of legal age, Filipino citizen, married and

with residence and postal address at Can-ayan, Malaybalay City, Bukidnon, after
having been duly sworn to in accordance with law, depose and say:

1. That, I am the biological father of JOCELYN BASALO who was born on

November 29, 1994 at Malaybalay City, Bukidnon;

2. That, the said JOCELYN BASALO is my biological child with my wife

GLORIA N. BASALO, however, my said child carried the family name BASALO, the
fact that I and my wife GLORIA N. BASALO are not yet married and only on March
27, 2003 that we were legally married;

3. That, being my biological child, and as in fact acknowledged her as my

child;

4. That, this affidavit is executed to attest to the truth of the foregoing

statements and for the purpose of acknowledging that JOCELYN BASALO is my
biological child with GLORIA N. BASALO.

IN WITNESS WHEREOF, I have here unto set my hand this 6 th day of

September, 2017 at Malaybalay City, Bukidnon.

IGNACIO R. PANONCIAL
[Affiant]
I.D. No.: 152008945661
Issued by: Philhealth

SUBSCRIBED AND SWORN to before me this 6th day of September, 2017 in

the City of Malaybalay, Bukidnon, Philippines.

Doc. No. ____

Page No. ____
Book No. _____
Series of 2017