Republic of the Philippines

Province of Leyte
Municipality of Palo

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, MARIIETTA M. NARAJA and ROWENA A. SELLOTE , Filipino, both of legal age,
residents Brgy. San Fernando, Palo, Leyte, Philippines after having been duly sworn in
accordance with law, hereby depose and state:
1. That we personally know MARIBEL C. CAPACIO who was born on January 12,
1969 in Palo, Leyte, Philippines;
2. That we personally know PRIMITIVO CAPACIO and CYNTHIA CORDEVILLA are
the parents of MARIBEL C. CAPACIO;
3. That it came to our knowledge that the fact of her birth has an error in the
office of the PSA – National Statistic Office;
4. That the reason why her name is erroneous were due to the fact that the
parents don’t have the knowledge of civil documentation during her birth;
5. That we could personally attest the truthfulness of the foregoing statements
because we are close friends and neighbors of the said registrant for a long
period of time;
6. That we are executing this affidavit to attest the truth of the foregoing
statements to support for the CHANGE of NAME
from MARYDEL CORDEVILLA CAPACIO TO MARIBEL CORDEVILLA CAPACIO
and whatever legal purpose it may serve.

IN WITNESS WHEREOF, We have hereunto affixed our signatures this July

26, 2019 in the Municipality of Palo, Leyte, Philippines.

MARIETTA M. NARAJA ROWENA A. SELLOTE

1st Affiant/Witness 2 nd Affiant/Witness
Signature over Printed Name Signature over Printed Name
SUBSCRIBED AND SWORN TO before me this -------------------------------------
at -----------------------------------------------------------------Affiants appeared and
affixed their signatures before me.
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