AFFIDAVIT OF ONE AND THE SAME PERSON

I, _________________________________________________________, of legal age, Filipino citizen,

single/married/widowed with Philippine address at _________________________________________________,
and with presently residing in ____________________________________________________, Kingdom of
Saudi Arabia, after having been duly sworn in accordance with law, hereby depose and state that:

1. I was born to spouses ___________________________________________________

and ______________________________________________________________ on
______________________________ in ___________________________________ and
was name in my Certificate of Live Birth/Report of Birth as
_____________________________________________________________________;

2. I have consistently used in all my transactions, personal or otherwise, the name

______________________________________________________________________;

3. When I applied for a Philippine passport, I used the name ________________________

_____________________________________________________________________;

4. In my ____________________________________________, my name appears to be

_____________________________________________________________________;

5. I am executing this affidavit to attest to the veracity of the foregoing statement to prove
that ____________________________________________________________ and
____________________________________________________________ are one and
the same person and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of _______________________
20____ in Jeddah, Kingdom of Saudi Arabia.

__________________________
Signature of Affiant

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FOREIGN SERVICE OF THE PHILIPPINES )
Consulate General of the Philippines ) S.S.
Jeddah, Kingdom of Saudi Arabia )

SUBSCRIBED AND SWORN TO before me this ____ day of _____________________ 20___ at the
Philippine Consulate General, Jeddah, Kingdom of Saudi Arabia.

Doc. no. : __________

Service no. : __________
Series of : __________
O.R. no. : __________ __________________________
Date : __________ Administering Officer