Republic of the Philippines}

Province of Quirino}
Municipality of Diffun}

AFFIDAVIT OF INTENT AND CONSENT

I, DIANNE MARLYN PONHALBAN, Filipino, of legal age, single and presently
residing at Diego Silang, Diffun, Quirino, having been duly sworn in accordance with
law, hereby depose and state:

1. That I am DIANNE MARLYN PONHALBAN who was born on March 28, 1998 in De
Vera’s Hospital Center, Santiago City;

2. That I am the biological daughter of my parents FELIPE B. DULNUAN and SUSAN P.

DULNUAN;

3. That FELIPE B. DULNUAN and SUSAN P. DULNUAN want to adopt me to raise my

status from illegitimate to legitimate;

4. That I am giving my consent to adopt me since they are my biological parents;

5.That I execute this affidavit to declare my intention and consent to the adoption as
well as to the truth of the foregoing facts.

IN WITNESS WHEREOF, we have hereunto set our hands this______day of May, 2018
at Diffun, Quirino.

DIANNE MARLYN PONHALBAN

Affiant

SUBSCRIBED AND SWORN to before me in the Municipality of Diffun this______day

of May, 2018.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

NotaryPublic
Until December 31, 2019
Doc No._____; PTR No. 3218465/ 01-03-2018
Page No.____; Lifetime IBP No. 17396/05-20-2017
Book No.03; ROLL No. 67812/05-26-2017
Series of 2018. (MCLE Governing Board Order No. s-2008)
Diffun, Quirino