REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

JOINT AFFIDAVIT OF COHABITATION

WE, BRYAN C. MEDINA and DIANA MAE A. DOMINGO, both

of legal ages, Filipino citizens, single and residents of 006-B, Dahlia Rd.,
San Luis, Baguio City, Philippines, after having been duly sworn to in
accordance with law, depose and state THAT:

1. We have been living together as husband and wife without the benefit of
marriage under the same roof, continuously and without any interruption,
since 2007 or a period of more than twelve (12) years;

2. During our cohabitation and even until the present, there exists no legal
impediment/s or obstacle/s between us to marry each other;

3. We are executing this affidavit to attest to the foregoing facts and for the
purposes of contracting marriage without the need of securing a marriage
license pursuant to the provisions of Article 34 of the Family Code of the
Philippines.

IN WITNESS WHEREOF, we have hereunto set our hands this 3 rd

day of April 2019 in Baguio City, Philippines.

BRYAN C. MEDINA DIANA MAE A. DOMINGO

Affiant Affiant
SSS ID No. 1452-2378604-8 SSS ID No. 5689-0624812-5

SUBCRIBED AND SWORN TO before me this 3rd day of April

2019 in Baguio City, Philippines.

Juan Pedro
Notary Public for Metro Manila
Notarial Commission N.A. -29-NC-18-R
My Commission Expires on December 31, 2019
ROLL NO. 83455 05-08-15; Manila
MCLE COMPLIANCE No. V-088889 7-03-15
PTR NO. 444658; 01-02-18; Metro Manila
IBP O.R. NO. 15555768; 10-26-17; Metro Manila Chapter

Doc No. 69
Page: 1
Book: IV
Series of 2019
 REPUBLIC OF THE PHILIPPINES)
CITY OF BAGUIO ) S.S.

AFFIDAVIT OF CORRECTION AND DISCREPANCY

I, DIANA MAE ADAN DOMINGO, of legal age, single, Filipino

citizen, and a resident of 006-B, Dahlia Rd., Baguio City, Philippines, after
having been sworn to in accordance with law hereby depose and state:

1. That I was born on September 2,1995 at San Luis, Baguio City, Philippines,
of Filipino parents, PEDRO C. DOMINGO and NENITA DAEZ ADAN
as my father and mother respectively;

2. That since birth up to the present, I have been using ADAN as my middle
name being the surname of my mother and DOMINGO as my surname
being the SURNAME of my father.

3. That when I secured a copy of my certificate of live birth before the

Philippine Statistics Office, I discovered that my middle name indicated
therein is DAEZ which is the middle name of my mother instead of ADAN
her surname, and my surname name indicated therein is ADAN my mother’s
surname instead of DOMINGO my father’s surname; A copy of my
certificate of live birth is hereto attached and marked as ANNEX “A” for
your reference.

4. That my true and complete name is DIANA MAE ADAN DOMINGO;

5. That DIANA MAE ADAN DOMINGO and DIANA MAE DAEZ ADAN
refer to one and the same person;

6. That I am executing this Affidavit to attest to the truthfulness of the

foregoing and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 3rd day

of April 2019 at Baguio City, Philippines.

DIANA MAE ADAN DOMINGO

Affiant
SSS ID No. 5689-0624812-5
 SUBSCRIBED AND SWORN to before me this 22nd day of
February 2016, Baguio City, Philippines.

Juan Pedro
Notary Public for Metro Manila
Notarial Commission N.A. -29-NC-18-R
My Commission Expires on December 31, 2019
ROLL NO. 83455 05-08-15; Manila
MCLE COMPLIANCE No. V-088889 7-03-15
PTR NO. 444658; 01-02-18; Metro Manila
IBP O.R. NO. 15555768; 10-26-17; Metro Manila Chapter

Doc No. 69
Page: 1
Book: IV
Series of 2019
 REPUBLIC OF THE PHILIPPINES)
CITY OF BAGUIO ) S.S.

AFFIDAVIT OF TRANSFEROR

I, DIANA MAE A. DOMINGO, single, of legal age, Filipino Citizen

and resident of 006-B, Dahlia Rd., Baguio City, Philippines, having duly
sworn to in accordance with law, do hereby depose and state that:

1. I am the transferor of a parcel of land with an area of ONE HUNDRED

(100) SQUARE METERS and covered by Transfer Certificate of Title
No.019-2378095631 and located at San Luis, Baguio City, Island of Luzon,
Philippines, by way of a DEED OF ABSOLUTE OF SALE OF REAL
PROPERTY docketed as Doc. No.19; Page No.2; Book No. VI; Series of
2018 of the Notarial Registry Book of Atty. MIRACQUEL P. PUYOC;

2. The land subject of the deed is a retention or portion of my retention area of

not more than five (5) hectares;

3. I am executing this affidavit in compliance with DAR Administrative Order

No.1, Series of 1989 and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereto set my hand this 3rd day of

April 2019, at Baguio City, Philippines.

DIANA MAE A. DOMINGO

Affiant
SSS ID No. 5689-0624812-5
 AFFIDAVIT TO USE THE SURNAME OF FATHER

I, BRYAN CANG MEDINA, of legal age, single, Filipino citizen

and resident of 006-B, Dahlia Rd., San Luis, Baguio City, after having duly
sworn to in accordance with law hereby depose and say:

1. That I am the biological father of RACHEL DOMINGO who was born on

January 27, 1996 at BAGUIO GENERAL HOSPITAL, Baguio City;

2. That the biological mother of RACHEL DOMINGO who was born out of
wedlock is DIANA MAE A. DOMINGO;

3. That the facts of birth of my child were duly registered at the Office of
Baguio City Civil Registrar;

4. That I, BRYAN CANG MEDINA, being the biological father of RACHEL

DOMINGO, hereby acknowledged and recognized her as my child and
legal heir;

5. That I am allowing and giving my full consent to my beloved daughter

RACHEL DOMINGO to use my surname MEDINA to be her surname in
her Certificate of Live Birth;

6. That the biological mother of my child, DIANA MAE A. DOMINGO,

agrees and consents to the use of my surname by our beloved child
RACHEL DOMINGO;

7. That I am executing this Affidavit to attest to the truthfulness of the

foregoing facts and in order to established the facts that RACHEL
DOMINGO is my beloved daughter and that she is allowed to use my
surname “MEDINA” and in compliance with the provisions of RA No.
9255 and its implementing rules and regulations and for legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 3rd day

of April 2019 at Baguio City, Philippines.

BRYAN CANG MEDINA

Affiant
SSS ID No. 1452-2378604-8
 With my consent

DIANA MAE A. DOMINGO

SSS ID No. 5689-0624812-5

SUBSCRIBED and SWORN to before me this 3rd day of April 2019,

at Baguio City, Philippines.

JOLLY JOY A. ALMOITE

Notary Public for Baguio City
Notarial Commission N.A. -29-NC-18-R
My Commission Expires on December 31, 2019
ROLL NO. 83455 05-08-15; Manila
MCLE COMPLIANCE No. V-088889 7-03-15
PTR NO. 444658; 01-02-18; Baguio City
IBP O.R. NO. 15555768; 10-26-17; Baguio-Benguet Chapter

Doc No. 69
Page: 1
Book: IV
Series of 2019