Republic of the Phillipines)

Quezon City)

AFFIDAVIT OF CHANGE NAME

That I, KEZIAH MURIELLE PAGADUAN SERRANO, married to BIRGHAM DANIEL P.

SERRANO, of legal age, Filipino and presently residing at B5 L1 Happy Homes Village, Bahay
Toro, Quezon City, after having been sworn to in accordance with law, hereby depose and state:

1. That I was legally married to BIRGHAM DANIEL P. SERRANO on May 03, 2019 at
Manila Philippines Temple;

2. That in my school record at Centro Escolar University, my fullname recorded as Keziah

Murielle Magbitang Pagaduan (single) before i got married and now that I am married to
BIRGHAM DANIEL P. SERRANO I want to change my maiden name to my husband's
surname and that is Serrano;

3. And now what I want to happen is to delete my old name when I was single from the
school record and change my new name because I'm married and that is KEZIAH
MURIELLE PAGADUAN SERRANO;

4. That the names Keziah Murielle Magbitang Pagaduan (single) and KEZIAH MURIELLE
PAGADUAN SERRANO (married) refers to one and the same person;

5. That, I am executing this affidavit to attest to the truth of the statements and for other
legal purposes that this may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this June 07, 2021, in Quezon City,
Metro Manila, Philippines.

KEZIAH MURIELLE PAGADUAN

SERRANO
Affiant

SUBCRIBED AND SWORN TO before me this June 07, 2021, in Quezon City, Philippines,
affiant exhibiting to me his/her competent evidence of identity by way of __________________
issued at ______________ on __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021