REPUBLIC OF THE PHILIPPINES )

PROVINCE OF _______________ ) S.S.

CITY OF _________________ )

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, _______________________ and _____________________, are both

of legal ages, Filipino citizens, and residents of _______________________, after
having been duly sworn to in accordance with law, do hereby depose and state under
oath that:

1. We personally know the person of _______________ who was born

______________________. The same has been registered with the Philippine
Statistics Authority (PSA);

2. We personally know the fact that in his Certificate of Live Birth on file with the
PSA and in his other pertinent Identification cards his name has been reflected
as “________________”− his true and correct name;

3. However, in his records with the SSS his name has been recorded as
“______________________” as this has been his known nick name by his
friends, relatives, and acquaintances;

4. We personally know this, though we are not his relatives neither by affinity
nor by consanguinity, considering that we live in the same barangay before
and we have been invited in some of their family gatherings;

5. This “_____________” and “__________________” refers to one and

the same person;

6. We are executing this affidavit not to defraud anybody but solely to attest to
the fact that there was merely a discrepancy as to the reflected name of
____________ in his SSS records;

7. We are further executing this affidavit to attest to the truthfulness of the

foregoing facts and for whatever legal intent and purposes it may serve.

Affiants further sayeth naught.

IN WITNESS WHEREOF, We have hereunto set our hands this

________________, at ______________.

_____________________ _________________
Affiant Affiant
ID No. ___________________ ID No. _________________
Issued by ___________ Issued by ________________

SUBSCRIBED AND SWORN to before me this _______________, at

_______________. Affiants exhibited to me their above written Identification cards
written just below theire names as competent proof of their identities.

Doc. No. :______;

Page No. :______;
Book No.:______;
Series of 2021.