REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

TABACO CITY )
x------------------------------------------x

AFFIDAVIT OF IDENTITY

I, ______________________________, of legal age, Filipino, single/married/widow/widower

and residing at ______________________________, after having been duly sworn to in
accordance with law hereby depose and state THAT:

1. (insert name/type of identification card)  I.D. with number ___________________ issued on

____________________ at _________________________________ indicating the name of
__________________________________________; and

2. (insert name/type of identification card) I.D. with number __________________ issued on

____________________ at _________________________________ indicating the name of
________________________________________ indicates both one and the same person;

3. I am executing this Affidavit to attest to the truth and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in
____________, _____________, Philippines.

___________________________________

Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of __________ 20____, in the City of
__________________, by ___________________ with Passport No.________________ issued
on __________________ at _____________.

ATTY. ANTHONY CLARK A. GAPIDO

Notary Public Tabaco City
For the Province of Albay
Roll No. 83746
IBP OR No. 227570; June 13, 2022
PTR No. 8843533; July 13, 2022 at Tabaco City
MCLE: N/A (Newly Admitted to the Bar)
2nd Floor Coastal Building Rental, Purok 2,
Morales Street, San Roque,Tabaco City, 4511

Doc No.____;
Page No. 450;
Book No. 35 ;
Series of 2022