Republic of the Philippines )
Province of ______________ ) s.c.
________________________ )
AFFIDAVIT
I, _________________________, of legal age, Filipino, and resident of 58
Banaoang, Calasiao, Pangasinan after having been duly sworn to in
accordance with law, do hereby depose and state:
1. That in my Certificate of Live Birth I was born to Renolfo
Sapiera and Elsie C. Sapiera at Calasiao, Pangasinan on May
22, 1980;
2. That in my Personal Data Sheet submitted to the Civil
Service Commission in support of my Appointment, I stated
therein that my place of birth is Dagupan City;
3. That I stated Dagupan City therein Dagupan City as my
place of birth believing that I was filling an information
relating to my address.
4. That I submitted said Personal Data Sheet without
reviewing the information I stated therein;
5. However, I discovered said discrepancy in my place of
birth and now I am correcting the same to conform with my
true and correct place of birth in my PSA Certificate of Live
Birth; and
6. That I am executing this affidavit in order to attest the
truth of foregoing circumstances and for all other intents
and purposes.
IN WITNESS WHEREOF, I have hereunto set my hands this _____ day of
August 2024 in the ___________________________________________.
RYAN C. SAPIERA
Affiant
ID/ID No:_____________________
SUBSCRIBED AND SWORN to before me on the date above written in the
______________________________________________, the Affiant personally
appeared.
DOC NO._________
PAGE NO.________
BOOK NO.________
SERIES OF 2024.
