Republic of the Philippines)

Province of So. Leyte........)S.S.

City of Maasin…………....)

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, MARIAN ORIT ACASIO, of legal age, Filipino, single, and a resident of Brgy.
Soro-Soro, Maasin City, Southern Leyte, after having been duly sworn to in accordance
with law hereby depose and say:

1. That I am a legitimate daughter of SPS. Presciana Orit and Eleuterio Acasio;

2. That I was born on May 8, 1979 at Maasin City, Southern Leyte;
3. That however, it appears from the records of the Local Civil Registrar and the
Philippine Statistics Office that my place of birth, which is the Province of
Southern Leyte is not indicated therein;
4. That it is my desire that the Province of Southern Leyte, being my place of
birth will be indicated in my Birth Certificate;

5. That I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose this may serves best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ at Maasin City, So. Leyte, Philippines.

MARIAN ORIT ACASIO

SSS ID No. 33-7836670-3 
Affiant

SUBSCRIBED AND SWORN TO, before me this _______________ at Maasin

City, So. Leyte, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2018