REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU ) S.S.

AFFIDAVIT
(Adding Middle Name in my SSS Record)

I, Billie Michael A. Ko of legal age, Filipino, single, and

a resident of _________________________, Philippines, after
having been duly sworn in accordance with law, hereby
depose and state THAT –

1. That the name Billie Michael _. Ko appearing on

attached copy of Birth Certificate1 issued by the National
Statistics Office with date of birth on ______ and Billie
Michael Ko with the same birth date as it appears on the
SSS record is one and the same person;

2. That the name Billie Michael Ko without a middle

name or middle initial on the record was due to an
unintentional omission or clerical error only;

3. That my full and correct name is BILLIE MICHAEL

__. KO as it appears on my Birth Certificate and other
government records;

4. Hence, I am executing this Affidavit to attest to

the truth of the foregoing as well as request to add
specifically my middle name on my SSS records and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand

this _____________ at Cebu City Philippines.

BILLIE MICHAEL __ KO
Affiant

SUBSCRIBED AND SWORN to before me this 12 May

2018 in Cebu City, Philippines, affiant exhibiting to me his
____ ID with ID # __________.

Doc. No. ___;

Page No. ___;
1
Herein attached and marked as ANNEX “A”
Book No. ___;
Series of 2018.