REPUBLIC OF THE PHILIPPINES)

SANTA CRUZ, LAGUNA ) s.s.

AFFIDAVIT CONCERNING FACTS OF BIRTH

I, LYDIA TEMPLONUEVO PUBLICO-BERNARDINO, of legal age,

Filipino, married to Gertrudo S. Bernardino, and a resident of Brgy.
Palasan, Santa Cruz, Laguna, after having been sworn in
accordance with law hereby depose and state that –

1. My name given immediately after the time of birth was LYDIA

TEMPLONUEVO PUBLICO. I was born on 17 SEPTEMBER 1961
in Bato, Catanduanes. My father is JOSE PUBLICO and my
mother is FE TEMPLONUEVO, both residents of Bato,
Catanduanes.

2. The actual date of my birth as it appears on my Certificate of

Live Birth issued by the Local Civil Registrar of Bato,
Catanduanes and the National Statistics Office (NSO) is 17
SEPTEMBER 1961.

3. If it appears in some of my record/s that there is a slight

discrepancy in the year of birth such as when the year 1961
was not correctly entered and another year was entered, the
same was an honest mistake which may have been caused
purely by inadvertence or clerical lapses.

4. To set the record straight and for all intents and purposes, I
hereby state under oath that my birth date is 17 SEPTEMBER
1961. This likewise serves to respectfully inform the
concerned government offices such as the Social Security
System (SSS) and other offices or agencies.

IN WITNESS WHEREFORE, I hereto affixed my signature this

_______________ in Santa Cruz, Laguna.

LYDIA T. PUBLICO – BERNARDINO

Affiant

SUBSCRIBED AND SWORN to before me this ______________

in Santa Cruz, Laguna by the affiant with Community Tax Certificate
No. ____________ issued at Santa Cruz, Laguna on____________.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2008.