Republic of the Philippines)

City of Zamboanga . . . . )s.s.

x- - - - - - - - - - - - - - - - -x
AFFIDAVIT
I, CHARLLOTTE SADY QUILALA DOLLOSO, of legal age, Filipino,
single and a resident of Block 4, Lot 29, HB Homes Subdivision, Zamboanga
City, Philippines, after having been sworn, depose and say that:
1. I am the daughter and Attorney-in fact of SUSAN QUILALA YSIANO in a
Special Power of Attorney (SPA) executed by her on April 15, 2014, a
faithful machine copy of which is hereto appended as ANNEX A
2.
3.

My mother was not able to have the said SPA notarized due to the fact
that April 18 was a legal Holiday and there was no open Notary Public to
have the same registered with the notary;

4.

I took and passed the Licensure Examination for Teachers which was
given on January 26, 2014 by the Professional Regulation Commission;

5. However, when I applied for the Professional Identification Card

Registration with the Professional Regulation Commission (PRC), it was
found out that there is a discrepancy in my date of birth. Records show
that my date of birth was entered as DECEMBER 19, 1988 in my PRC
application for the board examination given last January 26, 2014 instead
of my true and correct birth date that is DECEMBER 29, 1988;
6. I was in good faith, with no intent to deceive anyone when I applied for
the aforementioned board examination. Further, I have no previous
knowledge that such discrepancy exists in my application, so I was not
able to make the necessary correction prior to the taking of the
examination;
7. That it was only last March 28, 2014, when I registered for the oath taking
that I found out about the said discrepancy when I made an inquiry with
the PRC office in Zamboanga City;
8. It is the first time that such discrepancy in my date of birth happened;
9. That I execute this affidavit to attest to the truthfulness of the foregoing
statements for the purpose of correcting my date of birth and for
whatever legal purpose or purposes this may serve under the law.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my

signature this 21st day of April, 2014 at Zamboanga City, Philippines.
CHARLLOTTE SADY QUILALA DOLLOSO
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and
for City of Zamboanga this 21st day of April, 2014. Affiant personally came
and appeared with PRC License Card No.: 1178910 bearing her
photograph and signature, known to me as the same person who personally
signed the foregoing instrument before me and avowed under penalty of law
to the whole truth of the contents of said instrument.
Doc. No. _____
Page No. _____
Book No. _____
Series of 2014