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Republic of the Philippines ))

City of Calbayog )) s.s.


I, CRISTOBAL BALADJAY TABOY, Filipino, 43 years of age, with common-law partner,

and a resident of Barangay Bunyagan, Gandara, Samar, Philippines, after having been duly sworn
to in accordance with law, hereby depose and state, that--

1. I am a legal beneficiary of the government’s Unconditional Cash Transfer (UCT) and as

such, I was issued a beneficiary notification form in the name of CRIS TABOY
BALARJAY with UCT Listahan ID 086007014-2-10438699;

2. It can be gleaned from the records that there is a discrepancy in the name of the
beneficiary’s name and that of my real name;

3. In truth and in fact, my real name is CRISTOBAL BALADJAY TABOY as appearing in

my Certificate of Live Birth with Registry Number 2018-1691 (Late Registration) and
other identification like the Voter’s ID. My Father is CRISPEN PERANTE TABOY, while
my mother’s maiden name is NENITA ARRAS BALADJAY.

4. I declare that the name CRIS TABOY BALARJAY, as appearing in the beneficiary form,
refers to the same and one person of CRISTOBAL BALADJAY TABOY as appearing in
the above-mentioned legal document and as publicly known as such. The name CRIS
TABOY BALARJAY is erroneously written since my real name is CRISTOBAL and CRIS
is only my nickname or alias, and TABOY should be my Last name and BALARJAY
should be read and written as BALADJAY, as my middle name, for the same is my
mother’s maiden name;

5. I am executing this Affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of August 2018 in the
City of Calbayog, Samar, Philippines.



SUBSCRIBED AND SWORN TO BEFORE ME, this 30th day of August 2018 in the City of
Calbayog, Samar, Philippines. Affiant exhibited to me his VIN 6007-0070A-A2272CBT10000-2.


Public Attorney I
Pursuant to RA 9406

Doc. No. 539;

Page No. 27;
Book No. I
Series of 2018