Affidavit - Erroneous Entry - Seguis

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Republic of the Philippines)

Province of Surigao del Sur)


Municipality of Tago) s.s.
x- - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF TWO DISINTERESTED PERSONS


WE, EMELINA EMAN GONTENIAS and MARISSA A. MEJORADA, both
of legal ages, Filipinos and residents of Cortes, Surigao del Sur, Philippines, after
having been duly sworn to in accordance with the law, depose, and state:

1. That we personally know JOSE III DIO SEGUIS, who was born
on December 05, 2009 at P-5, B-72, L-16, Upper Bicutan,
Taguig City, to the spouses Veronica Pumarejo Dio and Jose
Sr. Salinas Seguis; he and his parents had been our neighbor
and our close friend for a long time;

2. That in his Certificate of Live Birth issued by the Office of the


Local Civil Registrar of Taguig City, Metro Manila, his name was
erroneously entered therein as JOSE JR. instead of JOSE III,
which is his true and correct first name;

3. That we hereby attest to the veracity of the foregoing and we


are not in any way related to JOSE III DIO SEGUIS within the
fourth civil degree either by consanguinity or affinity, nor do we
have any pecuniary interest in this matter whatsoever;

4. That we are executing this Affidavit to attest the veracity of the


foregoing and for all legal intents and purposes it may serve
best under the circumstance.

IN WITNESS WHEREOF, we have hereunto set our hands this 15 th day of


January, 2021 at Tago, Surigao del Sur.

EMELINA EMAN GONTENIAS MARISSA A. MEJORADA


Affiant Affiant
PhilHealth I.D. No. 18-025147191-4 4Ps I.D. No. 166808004-0232-00026

SUBSCRIBED AND SWORN to before me this 15th day of January, 2021


at Tago, Surigao del Sur.

ATTY. RONALD I. MAGALLANO


Notary Public
Doc No. ____ Under Serial No. SDS-07-2020
Page No. ___ Until December 31, 2021
Book No. ____ Roll of Attorneys No. 67773
Series of 2021. PTR No. 9109017 - 1/05/21
IBP No. 150721 – 1/13/21
MCLE Compliance No. VI-0012494
ATTY. RONALD I. MAGALLANO
Notary Public
Doc No. ____ Under Serial No. SDS-07-2020
Page No. ___ Until December 31, 2021
Book No. ____ Roll of Attorneys No. 67773
Series of 2021. PTR No. 9109017 - 1/05/21
IBP No. 150721 – 1/13/21
MCLE Compliance No. VI-0012494

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