Republic of the Philippines)

Province of __________________)S.S.
City/Municipality of ___________)x - - - - -
AFFIDAVIT OF SUPPLEMENTAL REPORT
I, _____________, Filipino, of legal age, (single / married / widow), and
resident of _____________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:
That I was born on _____________ at _____________ to the Spouses
_____________ and _____________;

That since I was young, I have always been known and called by the first
name "PEDRO" and that it is the same first name that I have been using in
all my documents and identification papers;

However, it appears from the records of the Office of the Civil

Registrar of _____________ City that I was registered therein without a
given first name;
That it is my desire to be registered with the said Office of the Civil
Registrar of _____________ City with the first name "PEDRO";
That the failure to state my first name was purely the inadvertence of my
parents who failed to do so because oftheir uncertainty at first as to what
name would be given me at the time of the registration of the facts of my
birth with the said office;
As such, I execute this Affidavit to certify or attest to the truth of the
foregoing facts and for whatever legal purpose that this Affidavit may serve.
IN WITNESS WHEREOF, I have set our hands this _____________, in the
_____________, Philippines.
Affiant

(JURAT)