Republic of The Philippines Sworn Attestation

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Republic of the Philippines )

Quezon City, Metro Manila )


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

SWORN ATTESTATION

I KAREEN P. EGENIAS ,Filipino citizen ,single, of legal age, with address at 731 A Litex Rd
Commonwealth Quezon City after being sworn in accordance with the law, do hereby depose
and state that I am the mother of the affiant in the Affidavit to Use the Surname of the Father
(AUSF), that my child JULIUS ARCANGEL EGENIAS ALATRACA is fully aware of the consequences
of the use of the surname of his father.

In witness whereof I hereby hereunto affixed my signature this day of ______________,


_____ 2019, in ________________________,_________________________.

_________________________________
Signature of Mother/Guardian
over Printed Name

SUBSCRIBED AND SWORN to before me this ________ day of ______________ in the


city/municipality of ______________________________________ affiant exhibiting
his______________________________ issued at _______________________ on
_______________ I certify that I personally examined the affiant and that he/she voluntarily
executed the foregoing affidavit and understood the contents thereof.

________________________________
Signature over Printed Name
of the Administering Officer

Doc. No. _____________________


Page No._____________________
Book No._____________________
Series of_____________________

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