REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

CORDILLERA ADMINISTRATIVE REGION
BRANCH 3
BAGUIO CITY

IN RE: CANCELLATION OF THE FIRST CIVIL CASE NO. 12345

CERTIFICATE OF LIVE BIRTH OF
TOM MUGTAR KEPT IN THE OFFICE
OF THE LOCAL CIVIL REGISTRAR
OF BAGUIO CITY.

JUDICIAL AFFIDAVIT OF
PETITIONER

I, KIM MUGTAR, of legal age, and living at Baguio City, petitioner in this case and as the
Legal Guardian of TOM MAKDER , after having been duly sworn, hereby attests that:

PRELIMINARY STATEMENT

The person examining me is Atty. Marlon Aedrian Lopez with office address at University
of Cordilleras, Baguio City. The examination is being held at the same address. I am
answering her questions fully conscious that I do so under oath and may face criminal
liability for false testimony and perjury.

PURPOSE: This affidavit/testimony of petitioner KIM MUGTAR is being offered to prove

that TOM MAKDER is registered with Certificate of Live Birth twice, the first on January 2,
2004 registered as TOM MUGTAR, and the second one on March 21, 2004 as TOM
MAKDER. The petitioner’s testimony is also offered to prove the legal basis for the
cancellation of TOM MAKDER’S, also known as TOM MUGTAR, first Certificate of Live
Birth.

1. Q. Please state your name and other personal circumstances for the record.
A. KIM MUGTAR, 21 years of age, resident of Baguio City and daughter of JOY
MUGTAR and DON MUGTAR.

2. Q. Are you the same KIM MUGTAR, the petitioner in this case?
A. Yes sir.

3. Q. Who is JOY MUGTAR?

A. She is my mother. It is upon her request that I filed this petition as she is weak
to attend any proceedings.

5. Q. Who is TOM?
A. Tom is my half-sister, 15 years of age, daughter of JOY MUGTAR and DON
MAKDER.

6. Q. Can you please state your reason for these petition?

A. We would like to cancel the first registration of live birth of my half-sister,
registered as TOM MUGTAR, and retain the 2nd registration of live birth,
registered as TOM MAKDER.

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7. Q. Can you please narrate the circumstance for the first birth certificate registered
to TOM?
A. Yes sir. When DON abandoned us, my mother suffered depression. During this
time she met TIM and became lovers resulting to her pregnancy with TOM.
When TOM was born, TIM had to travel aboard to undergo treatment of his
illness.

8. Q. What happened next?

A. After the birth of TOM, DON, who accompanied JOY in the hospital, told the
attending clerk that he is the father of TOM and provided the information in the
Birth Certificate of TOM.

9. Q. What is the reason for the 2nd Birth Certificate?

A. When TIM came back from abroad, he told Joy to register the child in Sto. Tomas,
La Union and to which TIM also acknowledge that he is the biological father of
TOM.

10. Q. Is JOY married to TIM MAKDER?

A. No sir.

11. Q. Why would you choose to cancel the first birth certificate?
A. TOM, in her personal records and school documents, has always used and is
always known as TOM MAKDER.

12. Q: What are you asking this court with respect to this case?
A: We pray that the Honorable Court would grant our petition to cancel the First
Birth Certificate and retain the Second Birth Certificate of TOM MAKDER.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of November
2018 at Baguio City.

KIM MUGTAR
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the city of
Baguio this 23rd day of November 2018. Affiant personally came and presented to me
her ___________________ ID issued by the ________________ on 2018 at Baguio City,
as valid and competent proof of her identity, known to me as the same person who
personally signed the foregoing judicial affidavit before me and avowed under penalty of
law to the veracity of the contents of said instrument.

Atty. Gustavo F. Dalen

Notary Public

Doc. No. ____ Commission Serial No. ____________________________

Page No. ____ Notary Public for Baguio City.
Book No. ____ Until December 31, 2019
Series of 2018. Office: __________________________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ; Baguio City
PTR No. _________ ; __/__/__ ; Baguio City
MCLE Compliance Cert. No. __________; __/__/__

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 SWORN ATTESTATION

I, ATTY. MARLON AEDRIAN LOPEZ, of legal age, Filipino, with office address at
University of the Cordilleras, Gov. Pack Road, Baguio City after being duly sworn depose
and say:

1. I was the one who conducted the examination of petitioner KIM MUGTAR at
my afore-stated office.

2. I have faithfully recorded or caused to be recorded the questions I asked and

the corresponding answer that the petitioner gave;

3. Neither I nor any other person then present or assisting her coached the
petitioner regarding her answers;

IN WITNESS WHEREOF, I have hereunto set my hand this 23RD day of November
2015 at Baguio City.

ATTY. MARLON AEDRIAN LOPEZ

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the city of
Baguio to me her ___________________ ID issued by the ________________ on 2018 at
Baguio City, as valid and competent proof of her identity and swore to me under oath of
the veracity of her allegations.

ATTY. GUSTAVO F. DALEN

Notary Public

Doc. No. ____ Commission Serial No. ____________________________

Page No. ____ Notary Public for Baguio City.
Book No. ____ Until December 31, 2019
Series of 2018. Office: _______________________________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ; Baguio City
PTR No. _________ ; __/__/__ ;Baguio City
MCLE Compliance Cert. No. __________; __/__/__

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