REPUBLIC OF THE PHILIPPINES )

CITY OF CABANATUAN ) S.S.

AFFIDAVIT

That I, KARINA D. REVILLA, of legal age, Filipino and a resident of Mulawin I, Bitas,
Cabanatuan City, after having been sworn to in accordance with law, do hereby depose and state the
following:

1. That I am the legitimate daughter of Sps. Sps. Eugenio Domingo and Araceli Domingo;

2. That I got married to Edwin R. Revilla on June 4, 2001;

3. That we have 2 children, Karwin Emilio D. Revilla and Euxel Karmyna D. Revilla, both
minors;

4. However, since 2005 my husband disappeared and has been unheard of since then. Thus, I
am now a separated de pacto for 6 years now and am not receiving any support, financial,
moral or otherwise, from my husband;

5. That this Affidavit is to attest to the truthfulness of this fact for any legal intents and
purpose.

IN WITNESS WHEREOF, I have hereunto set my signature this 7th day of April, 2011 at
Cabanatuan City.

KARINA D. REVILLA
Affiant

SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed the
foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )
CITY OF CABANATUAN ) S.S.

AFFIDAVIT OF DISCREPANCY

That I, IMELDA B. CRUZ, of legal age, Filipino and a resident of 221 Mosses Geld St.,
Bantug Bulalo, Cabanatuan City, after having been sworn to in accordance with law, do hereby
depose and state the following:

6. That I am the legitimate daughter of Sps. Teodolfo Cruz and Felomina B. Buat as per
attached copy of our National Statistics Office (NSO) Birth Certificate attached herewith
and marked as Annex “A”;

7. That eversince my elementary school days I am habitually and continuously using the name
IMELDA B. CRUZ as my name and even in my following documents;
a. Transcript of records, Related Learning Experience, Diploma;
b. Certificate of Registration as Registered Nurse;
c. And in my other credentials

8. That I got married to Ceferino Salamat on April 13, 1994. However I am now a separated de
pacto for ten years now and am not receiving any support, financial or otherwise, from my
husband;

9. That I have used SALAMAT as my surname for the renewal of my passport since I am not
yet legally separated with my husband;

10. That the person named IMELDA B. CRUZ in the NSO Birth Certificate and the person
named IMELDA CRUZ SALAMAT in the passport is one and the same person; and
 11. That this Affidavit is to attest to the truthfulness of this fact for any legal intents and
purpose.

IN WITNESS WHEREOF, I have hereunto set my signature this 28TH day of September,
2010 at Cabanatuan City.

IMELDA B. CRUZ
Affiant

SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed the
foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL.

singletomarried