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REPUBLIC OF THE PHILIPPINES }

City of xxx } S.S.


x-----------------------x

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, XXX, Filipino, of legal age, and a resident of xxx, after being duly sworn in
accordance with law, depose and state that:

1 I was born on xxx at xxx to the spouses xxx and xxx;

2 I am male;

3 However, it appears from the records of the Office of the Civil Registrar and
Philippine Statistics Authority that I was registered therein without a gender;

4 It is my desire to be registered with the said government offices with the gender
“male;”

5 The failure to state my gender was purely due to the inadvertence of my parents
who failed to notice that my Certificate of Live Birth did not contain any
information as to my gender; and

6 Thus, I execute this affidavit to establish the truth of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this xxx at xxx City.

XXX
Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated above, the
affiant exhibiting to me his xxx, as competent proof of identity.

xxx

Doc No. _____


Page No. _____
Book No. _____
Series of 2018