Republic of the Philippines )

Municipality of Baras ) S. S.
Province of Rizal )

AFFIDAVIT OF LEGITIMATION

WE, ______________________________ and ________________________________,

husband and wife, both of legal ages, Filipino citizens, and presently residing at
___________________________________________ , after having been duly sworn to in
accordance with the law do hereby depose and say:

That, we are the parents of _________________________________, who yet
married although we are not disqualified by the impediment to marry to each
other during that time;

That, we were married sometime on ___________________________________

at ___________________________________________ ;

That, by virtue of the foregoing,we do now invoke the legitimation of
______________________________________ under the provisions of Article 177 to
Article 180 of Executive Order No. 209, as amended by Executive order no. 227
(Family Code of the Philippines), and that henceforth, we hereby request all the
authorities concerned to effect the change of his/her name in all existing birth
records from _________________________________________________________ to
___________________________________________________________________.

FURTHER AFFIANTS SAYETH NONE.

IN WITNESS WHEREOF, we have hereunto affixed our names this
__________ day of __________________, at Baras, Rizal, in front of two
instrumental witnesses.

_______________________________________ _______________________________________
(Affiant) (Affiant)
CTC No. ____________ CTC No. ____________
Issued At ___________ Issued At ___________
Issued on ___________ Issued on ___________

SIGNED IN THE PRESENCE OF:

_______________________________________ ______________________________________
witness witness

SUBSCRIBED AND SWORN TO BEFORE ME, this ____________ day of

_______________________________, 20___, affiants exhibited to me their respective
Community Tax Certificates.

Doc. No. ________

Page No. ________
Book No. _______
Series of _________