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REPUBLIC OF THE PHILIPPINES)

____________________________ ) S.S.

AFFIDAVIT

I, ANNABEL GATIP GOZUM, of legal age, Filipino citizen, married and with postal
address at Cabetican, Bacolor, Pampanga, Philippines, after being sworn into in accordance with
law, hereby depose and state that –

1. I am the grandmother of DHEMIN HACKIRO GOZUM AHN [DHEMIN];

2. DHEMIN’s mother, DANDHIA LAINE GOZUM [DANDHIA], is my daughter;

3. DHEMIN and DANDHIA are presently in South Korea;

4. My grandchild, DHEMIN, is applying for a Person With Disability (PWD) card in


South Korea;

5. In support of aforesaid application, I have assisted in the procurement of the


documentary requirements which were issued and obtained here in the Philippines and will be
transmitted to my daughter and grandchild in South Korea. Copies of said documents are
attached and made an integral part of this affidavit;

6. I am thus executing this affidavit to attest the authenticity and veracity of all the
documents I submitted;

7. Finally, I am executing this affidavit to attest to the truth of the foregoing facts
and for whatever legal intents and purposes that it may serve

IN WITNESS WHEREOF, I have hereunto affixed my signature this


________________________, in the City of San Fernando, Philippines.

ANNABEL GATIP GOZUM


Affiant

SUBSCRIBED AND SWORN to before me, this _____________________ at City of


San Fernando, Pampanga, affiant exhibiting to me her Passport No. P2058664C valid until 16
OCT 2032 bearing her photograph and signature as competent evidence of her identity.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2023.

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