REPUBLIC OF THE PHILIPPINES )

LAS PIÑAS CITY ) S.S.

AFFIDAVIT

I, ESTRELLA DE GUIA MEDINA, of legal age, Filipino and presently

residing at No. 110 Mirror Street, Manila Times VI, Pamplona Tres, Las Piñas
City, after having been duly sworn to in accordance with law, depose and say:
1. That I am an applicant of a Green Card in the City of Las Piñas who is
presently seeking for the benefits that are entailed in the said Health
Care Program of the Las Piñas City Government.
2. That a Certification, dated December 01, 2014 was issued to me by
Hon. Jose Mauricio Agustin R. Riguera, Barangay Captain of Barangay
Pamplona Tres attesting that I am a bona resident of No. 110 Mirror
Street, Manila Times VI, Pamplona Tres, Las Piñas City
3. That in the Voter’s Identification Card or Voter’s ID issued to me by the
Commission on Elections, it was mistakenly stated in my civil status
that I am “married” when in fact my marriage certificate was not even
registered with the National Statistics Office.
4. That with the non-registration of my marriage certificate with the
National Statistics Office, it goes to show that I am not married and
would, thus, prove that the civil status of “married” in the Voter’s ID is
not true and that my civil status should be “single.”

5. That in the Certification issued on December 01, 2014 by Hon. Jose

Mauricio Agustin R. Riguera, Barangay Captain of Barangay Pamplona
Tres, Las Piñas City and in the COMELEC Voter’s ID, both documents
were issued to ESTRELLA MEDINA MABATID which is one and the
same as my name Estrella De Guia Medina, the name appearing in
my application for Green Card in the City of Las Piñas and this sworn
statement.
6. That I am executing this sworn statement to attest to the truth and
veracity of the allegations herein stated and to request the Office of the
City Mayor and the Department of Social Welfare and Development of
Las Piñas City to issue the Green Card in my name and stead as I
have substantially complied with the necessary requirements provided
for by law.
AFFIANT SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
______ day of _______________, 2014 at Las Piñas City.

ESTRELLA DE GUIA MEDINA

Affiant
SUBSCRIBED AND SWORN to before me this ______ day of
_________________, 2014 at Las Piñas City.

Doc. No. ______;

Page No. ______;
Book No. ______;
Sinumpaang salaysay nina Page 2
Carlos at Salome Coloso
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Series of 2014