Republic of the Philippines )

Province of Leyte )
Municipality of Villaba ) S.S.
x-----------------------------------x

AFFIDAVIT OF SUPPLEMENTAL REPORT

I, JULITA C. YOCTE, Filipino, of legal age, married, and resident of Brgy. Hinabuyan,
Villaba, Leyte, Philippines, having been duly sworn in accordance with law, hereby depose and
state:

1. That I am the mother of JOSELITO C. YOCTE, who was born on July 17, 1998 at
Hinabuyan,Villaba, Leyte;

2. That when he secured an authenticated copy of his Certificate of Live Birth from the
National Statistics Office (NSO), he found out that the entry for his “Maiden citizenship” was
inadvertently left blank when in truth and in fact that his maiden citizenship is “Filipino”.

3. That it is my desire that the foregoing facts be registered with the Office of the Civil
Registrar of Villaba, Leyte, and that in his Certificate of Live Birth, the entry “Maiden citizenship:
Filipino” will appear therein;

4. That the failure to state his maiden certificate in his Certificate of Live Birth was purely
because of my inadvertence because I was the one who failed to do so at the
time of the registration of the facts of his birth with the said office;

5. As such, I execute this Affidavit to certify or attest to the truth of the foregoing facts and
for whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have set our hands this 28th day of December 2018 at
Villaba, Leyte, Philippines.

JULITA C. YOCTE
Affiant

SUBSCRIBED AND SWORN to before me, this 28th day of December , 2018 at
Villaba, Leyte, by the Affiant who is personally known to me (or whom I have identified through
competent evidence of identity) and who exhibited to me her Voter’s ID No. 3751-0063A-
G63062JCY20000 issued at COMELEC.

NOTARY PUBLIC

Doc. No.507;
Page No. 102;
Book No. XV;
Series of 2018.