REPUBLIC OF THE PHILIPPINES )

____________________________ ) S. S.

AFFIDAVIT OF ACKNOWLEDGMENT
AND AUTHORITY /PERMISSION TO USE SURNAME

I, JULIUS L. SERMO, of legal age, Filipino, single, presently residing at

4579, V. Francisco Street, Sta. Mesa, Manila, after having been sworn to in
accordance with law, hereby depose and say:
1. I am the biological father of KATHERINE KATE
MORTERO QUIAMBAO A.K.A KATHERINE KATE MORTERO
who was born on 18 February 1992 to ANNALIZA F.
MORTERO.

2. As the biological father of KATHERINE KATE

MORTERO QUIAMBAO A.K.A KATHERINE KATE
MORTERO, I allow her to use my surname as proof of our
relationship and paternity.

3. I am executing this Affidavit in order to give

permission/authority for my child, KATHERINE KATE
MORTERO QUIAMBAO A.K.A KATHERINE KATE
MORTERO, to use the surname QUIAMBAO for all legal intents
and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 11

January 2019 in the City of Manila.
JUN R. QUIAMBAO
Affiant

SUBSCRIBED AND SWORN to before me this 11 January 2019 in

the City of Manila, the affiant exhibiting to me his Pag-IBIG MID No. 1090-
0434-5924.

ADMINISTERING OFFICER