Republic of the Philippines)

Province of Pampanga )s.s

Municipality of San Fernando )

AFFIDAVIT
CHANGE OF CIVIL STATUS

I, NICOLE B. INOC, of legal age, married, Filipino and a resident of of Prado

Siongco Lubao, Pampanga , after having been duly sworn in accordance with law do
hereby depose and say:

1. That I married CARLO M. INOC on July 25, 2019. Copy of my marriage

certificate is hereto attached as Annex “A”;

2. That my civil status appearing in the my records with the Bureau of Internal
Revenue is SINGLE whereas, my name appears as NICOLE L.
BERNARDINO, my maiden name;

3. That I am now married, hence, my civil status in my records with the BIR
should be changed SINGLE to MARRIED and my name from NICOLE L.
BERNARDINO to NICOLE B. INOC;

4. That this change of status and name was made without intent of defrauding
nor evade obligation which might result to fraud to contracts;

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereby affixed my signature below this affidavit this

_____ day of _________________hereat ____________________.

NICOLE B. INOC
Affiant

SUBSCRIBED AND SWORN TO, before me this ____day of __________hereat

__________________.

Doc. No. ________;

Page No. ________;
Book No. _______;
Series of 20____