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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA )S.S.


MUNICIPALITY OF GUAGUA )

AFFIDAVIT

I, CARMEN C. SAMPANG of legal age, Filipino, widow and a resident of


284 Cabangcalan, Floridablanca, Pampanga after having been duly sworn to in
accordance with law, hereby depose and say, that:

1. I am the mother of Lorina C. Sampang who was born on 16 April


1962 in Cabangcalan, Floridablanca, Pampanga through Benita Manacmul, who
is the attending midwife during said birth;

2. That her true and correct birthdate is 16 April 1962 and NOT 19
September 1972;

3. However, Lorina C. Sampangs birth was registered late. Her birth


was registered in the year 1972 together with her brothers birth who was the one
born on 19 September 1972;

4. Also, Lorina C. Sampang was not born with a twin as reflected in


her birth certificate;

5. That the errors were probably made by reason of confusion on the


part of the clerk who made in the entries in her birth certificate;

I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of


May 2017 in Guagua, Pampanga.

CARMEN C. SAMPANG
Affiant

SUBSCRIBED AND SWORN, to before me this 8th day of


May 2017 in Guagua, Philippines, by CARMEN C. SAMPANG , who has
satisfactorily proven to me her identity through her Senior Citizen ID No. 2551
bearing her signature and photo.

WITNESS MY HAND AND SEAL OF OUR OFFICE

Doc. No. 18; ATTY. ANNA CAMILLE M. TADEO


Page No. 04; Public Attorney I
Book No. I; (Pursuant to R.A. 9406)
Series of 2017.