REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BULACAN ) S.S.

CITY OF SAN JOSE DEL MONTE )

AFFIDAVIT OF CONSENT
I, ____________________________, Filipino, of legal age, and a
resident of _____________________________, City of San Jose del
Monte, Bulacan, after having been duly sworn in accordance with law, hereby
depose and state:

1. That, I am the biological mother of ALYZA SALVADOR who was born

on the 24th day of March 2003;

2. That, at the time of birth of my daughter, ALYZA SALVADOR, her

biological father in the name of HERSON RIVERA BARREDO and me
were not married, copy of the Birth Certificate of the herein subject
child duly acknowledged is attached hereto as Annex “A” and made
integral part hereof;

3. That, I am giving my full consent of the subject child ALYZA

SALVADOR to use the surname of her biological father HERSON
RIVERA BARREDO for purposes of Registration before the Office of
the City Civil Registrar of the City of San Jose del Monte, Bulacan;

4. That, the subject child ALYZA SALVADOR after giving my full consent
as biological mother be registered as ALYZA SALVADOR
BARREDO before the City Civil Registrar, this City after the biological
father HERSON RIVERA BARREDO executed an instrument,
“Affidavit to Use the Surname of the Father”, copy of which is
attached hereto as Annex “B” and made integral part hereof

5. That, I am executing this instrument to attest the truth of the foregoing

facts and for whatever legal intent and purposes it is deemed proper.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my signature this ___ th day of

October 2008 at City of San Jose del Monte, Bulacan.

EULALIA G. SALVADOR
Affiant
CTC No. 06520932
Issued on October 7, 2008 at CSJDM

SUBSCRIBED AND SWORN to before me this __th day of October 2008

at City of San Jose del Monte, Bulacan, affiant exhibiting to me her CTC No. as
shown below her signature.

Doc No. ___;

Page No. __;
Book No. __:
Series of 2008