Republic of the Philippines )

Lingayen, Pangasinan ) S.S.

x----------------------------------------x

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

KNOW ALL MEN BY THESE PRESENTS:

We, __________________ and _______________ both of legal ages, Filipinos, and residents of
________________________, after having been duly sworn to in accordance with law, hereby depose
and state:

1. That we know ____________________, who was born on _______________ in

____________________________
2. That the true and correct full name is ______________________ indicated in Marriage
Contract.

3. That however, in her Birth Certificate, her name was erroneously placed therein as
____________________________________

4. That it also appears in her Passport as _______________________________

5. That the name ___________________ and ______________________ refers to one and the
same person

6. That we are executing this joint affidavit to attest to the truth of the foregoing and for whatever
legal purpose/s this may serve.

FURTHER AFFIANTS SAYETH NONE.

IN WITNESS WHEREOF, we have hereunto affixed our respective signatures this 16 th day of October,
2019 in ___________________________.

_________________________ ___________________________
Affiant Affiant
ID No. ______ ID No. ______

SUBSCRIBED AND SWORN to before me this _______ day of _________________ in Lingayen,

Pangasinan, Philippines, the affiants exhibiting to me their Government issued IDs written below their
respective names.

Notary Public

Doc No._______;
Page No. ______;
Book No. ______;
Series of 20 ____.