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REPUBLIC OF THE PHILIPPINES)City of Cebu) S.S.x - - - - - - - -
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AFFIDAVIT OF SUPPLEMENTAL REPORT
I, DANIEL GUIDOTTI, Filipino, of legal age, married and a
resident ofSitio Cogon, Basak, Pardo, Cebu City, Philippines having
been duly sworn inaccordance with law, hereby depose and state:
1. That I was born on August 3, 1950, at Cebu Maternity House,
CebuCity, Philippines to the spouses MARCO MONTENEGRO and
EMILYGUIDOTTI;
2. That since birth until present, I have been using the name
DANIEL as evidenced in my Certificate of Live Birth issued by the
Local CivilRegistrar of Cebu City, employment records and
representation inthe community;
3. That when I secured a copy of my Certificate of Live Birth
with theNational Statistics Office under Registry Number 4176, it
was shownthat I was registered therein with a first name BABY;
4. That it is my desire to register in the said National
Statistics Office(NSO) with a first name DANIEL ;
5. That the failure to state my true and correct name was purely
due tothe inadvertence of my parents who failed to do so because of
theiruncertainty in deciding as to what name would be given to me
at thetime of the registration of the facts of my birth with the
said office;
6. As such, I execute this Affidavit to certify or attest to the
truth ofthe foregoing facts and to process the registration of the
abovementioned name with the National Statistics Office and for
whateverlegal purpose that this Affidavit may serve.
IN WITNESS WHEREOF, I have set my hand this 29th day of
August,2012, in Cebu City, Philippines.
DANIEL GUIDOTTIAFFIANT
I.D. No. 999Issued by:SSS
SUBSCRIBED AND SWORN to before me, this 29th day of August,
2012by the Affiant whom I have identified through competent
evidence of identity andwho exhibited his Government Issued
Identification Number as per descriptionappearing below his
name.
Doc No.: _____;Page No.: _____;Book No.: _____;Series of:
2012.
