REPUBLIC OF THE PHILIPPINES }

CITY OF _____________________ } S.S.

JOINT AFFIDAVIT OF IDENTITY BY TWO DISINTERESTED PERSONS

(ONE AND THE SAME PERSON)

We, _____________________________________________, of legal age, with address at

____________________________and ________________________ of legal age and with
address at ___________________________, after having been duly sworn to hereby depose
and state as follows:

1. That we personally know _____________________ having been born on

_______________________ and known to us by the name of
____________________________.
2. That ______________________ was also known by ____________________ as
__________________
3. That the name on the birth certificate of ___________________, however, he has been
using another name ________________________.
4. All the records of ___________________regarding Social Security System carried the
name _______________________
5. That ________________ and ______________________ are one and the same person.
6. I am executing this Affidavit to clarify any discrepancy in my social security system
record for purposes of claiming my retirement benefits.
7. That I am executing this Affidavit to attest to the truth of the foregoing facts and for the
purpose of annotating in the records of the Social Security System with number
_________________ and for whatever this may legally serve.

In Witness Whereof, I hereby affixed my signature this ___ day of___________________,

2022 in the City of ___________________.

___________________________
Affiant

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________ day of ______________,

2022s, in the City of ____________, Affiant exhibiting to me their government issued ID in the
form of ___________________________.

Doc. No. ________;

Page No._________;
Book No. ________;
Series of 2022