Anda di halaman 1dari 1

Republic of the Philippines)

City of Legazpi ) s.s.


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

AFFIDAVIT

I, Juana Dela Cruz, of legal age, Filipino, single with residence and postal
address at Cristo Rey, Baao, Camarines Sur after having been duly sworn in
accordance with law, do hereby depose and state, that:

1. That I was born on October 18, 1990 at Cristo Rey, Baao, Camarines Sur
and a Certificate of Live Birth was registered with the Local Civil Registrar of Baao,
Camarines Sur.

2. That when I secured a NSO copy of my Certificate of Live Birth, I found


out that the entry for my Sex/Gender was erroneously indicated as Male when in
truth and in fact I am a Female.

3. I am executing this affidavit to attest to the truthfulness of the


foregoing declarations and for the purpose of solemnization of marriage and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of


November, 2014 at Legazpi City, Philippines.

LAWRENCE M. BUENAOBRA
Affiant

SUBSCRIBED AND SWORN to before me this 10th day of November, 2014 at


Legazpi City, Philippines.

Doc. No. ____;


Page No. ____;
Book No. ____;
Series of 2014.