REPUBLIC OF THE PHILIPPINES

)
City of xxx
) S.S.

AFFIDAVIT
I, ____ of legal age, single, Filipino, with residence at ______ after having
been duly sworn to in accordance with law, do hereby say and certify:
That there is a discrepancy in the entry of my live birth certificate wherein
the gender stated therein is male when in fact I am a female;
That I filed a petition for correction of entry in my Certificate of Live Birth;
That the petition that I filed is currently pending before ______ and still to
be raffled, the case is docketed as Special Proceeding No. 2012-10. Attached
hereto is a copy of the Petition as Annex A;
And that I have executed this statement to attest that I am a female and
not male as appearing on my live birth certificate and for other legal purpose it
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this_____

____________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this ______, affiant
exhibited to me her Community Tax Certificate No._____ issued ______

_______________________________
Public Attorney II
(Pursuant to Republic Act 9406)