Republic of the Philippines )

Province of ) S.S.

AFFIDAVIT

I, ______________, of legal age, Filipino, married, with residence and postal address at
______________, after having been sworn to in accordance with law, hereby depose and state
that:

1. I am one of the grantees of two parcels of land located in ___________,

issued under the name of ___________, and covered by Original Certificate
of Title (“OCT”) _______ (Annex “A”), which was issued by the Registry of
Deeds for the Province of Surigao del Norte (collectively, “Titles”);

2. At the time the Titles were issued, I was still single and was using the name
“____________” or “___________”. Attached hereto is a copy of my birth
certificate as evidence of my maiden name (Annex “B”);

3. However, the Registry of Deeds erroneously placed the name

“____________” instead of “__________” on the Titles;

4. I am currently married and have been using the name “______________”, as

evidenced by the attached identification card (Annex “C”);

5. I hereby confirm that “_____________”, “____________”, and

“___________” are one and the same persons; and

6. I am executing this affidavit to attest of the truth of the foregoing facts.

IN WITNESS WHEREOF, I hereunto affix my signature this …. day of …… 2018 at

………………, Philippines.

…………………
Affiant

SUBSCRIBED AND SWORN to before me this … day of …. 2018 at ………, ………, Affiant
exhibited to me her Identification Card No. …………. issued on ……… as competent proof of
her identity.

Notary Public

Doc. No. …..

Page No. …..
Book No. …..
Series of 2018.