REPUBLIC OF THE PHILIPPINES)

Province of Camarines Sur) S.S.

City of Naga)
x-----------------------x

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, ALFREDO MICHAEL B. MATALOTE II, of legal age, Filipino, married and

presently residing at Cararayan, Naga City after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the biological father of MICHAELLA MAE PERICO;

2. That the biological mother of the child is REBY B. PERICO;

3. That our child was born on June 3, 2005 at Binagasbasan, Garchitorena,

Camarines Sur;

4. That I, ALFREDO MICHAEL B. MATALOTE II being the father

of MICHAELLA MAE PERICO, hereby acknowledged and recognized her as my
child and legal heir;

6. That I am allowing my child MICHAELLA MAE PERICO to use

my surname MATALOTE to be her surname in her Certificate of Live Birth and
such other documents as may be applicable; and

7. That I execute this affidavit to attest to the truth of the above facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at

Naga City, Philippines.

ALFREDO MICHAEL B. MATALOTE

II
Affiant

SUBSCRIBED AND SWORN to before me this _________ in the City of

Naga, Philippines, affiant exhibiting to me his competent evidence of identity by way of
his GSIS eCard No: 957-0429412-014 indicating his GSIS ID No. 66061700847.
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Series of 2017 Notary Public