REPUBLIC OF THE PHILIPPINES)

LAS PINAS CITY

METROPOLITAN, MANILA

)
) S.S

AFFIDAVIT OF EXPLANATION
I,
Marina Dorado Calingasan________, of legal age, Filipino and with
residential address
at ____Brgy. Sto. Angel, San Pablo City____________________________________________,
after
having been sworn hereby depose and say:
1
2
3

That I am a Registered Midwife by profession;

That as such, I am the owner / administrator of SSMC Paanakan
located at the address stated above.
That the said business (birthing facility) does not perform permanent
sterilization
procedures such as Bilateral Tubal Ligation (BTL) and Vasectomy because it is
absolutely prohibited in our clinic.

4. That I am executing this affidavit to attest to the truth of the foregoing and
for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have been hereunto affixed my signature this

______________
At Las Pinas City, Metro Manila.
Marina Dorado
Calingasan
Affiant/Midwife
PRC I.D No.:_0059075__

SUBSRCIBED AND SWORN to before me this __________, affiant exhibiting to

me her
genuine identity document.

Doc.No. ___
Page No. __
Book No. __
Series No.