REPUBLIC OF THE PHILIPPINES)

Batangas City ) S.S.

x--------------------------x

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, RECHELLE I. BALIWAG, single, Filipino, of legal age

and a resident of Bolbok, Batangas City, having been duly sworn
in accordance with law, hereby depose and state, that:

[1] I was born on November 11, 1990, at Bolbok,

Batangas City to spouses Carlito Rivera Baliwag and Imelda
Aldover Ilagan;

[2] When I secured a copy of my Certificate of Live Birth

with the Philippine Statistics Authority under Registry Number
90-6881, it was shown that the Municipality of my Place of Birth
is not indicated thereon;

[3] It is my desire to register in the Office of the Batangas

City Civil Registrar and the Philippine Statistics Authority, the
Municipality of my birth place which is Batangas City;

[4] I execute this Affidavit to certify and attest to the

truth of the foregoing facts and to process the registration of
the above mentioned municipality with the Office of the
Batangas Civil Registrar and Philippine Statistics Authority and
for whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have set my hand this 21st day

of March, 2019, in Batangas City.

RECHELLE I. BALIWAG
Affiant
UMID: CRN-0111-1766322-9

SUBSCRIBED AND SWORN to before me, this 21st day of

March, 2019 by the Affiant whom I have identified through
competent evidence of identity and who exhibited her Unified
Multi-Purpose ID with number as per description appearing
below her name.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2020
 PTR No. 3308861 01-03-19 Batangas City
IBP Lifetime No. 019079
Doc. No. Roll No. 69544 Serial No. 2017-20
Page No. MCLE Exempted, pursuant to MCLE
Book No. Governing Board Order No. 1, S.2008
Series of 2019. Zenaida Arcade, 43 M.H. del Pilar St.,
Batangas City