AFFIDAVIT OF CONFIRMATION

I,__
BUSH D. BACULI________A Filipino of legal age, a resident of DACALAN,
TANUDAN, KALINGA__, a bonafide member of the Philippine National Police with the Rank
of _POLICE OFFICER 1___and assigned at SAF TRAINING BRANCH FORT STO.
DOMINGO, STA. ROSA CITY, LAGUNA. After having been duly sworn to in accordance
With law, do hereby depose and says that:
1.

Pursuant to this affidavit, we confirming that the named below are my legal
beneficiaries and/or heirs, to wit:

NAME
RELATIONSHIP
BLESSY CHARM C. BACULI
_DAUGHTER
RYKIEL BRAVE C. CULLAPOY
SON_______

BIRTH DATE
04/10/2011
06/02/2012

2. My relationship with the persons whose names are listed above are borne out
by the fact that we are the lawful parents and the legitimate/illegitimate father/mother of
the afore-named children as evidence by the attached marriage contract and birth
certificate:
3.I hold my self criminally and administratively liable for perjury and dishonesty
should any statements made herein are inaccurate or later on found to be false and in of
law.
AFFIANT SAYETH NAUGHT:

_______________________
(Affiant)
SUBSCRIBED AND SWORN to before me this ____day of ______________at
___________________________________________ Philippines.

Doc No.______________
Page No._____________
Book No._____________
Series No._____________