REPUBLIC OF THE PHILIPPINES}
CITY OF MAKATI } S. S.
AFFIDAVIT
I, AMOR , of legal age, single and residing at No. ______________, Makati City,
Philippines, after being duly sworn hereby depose and say that:
1. I was born on ______________ in the City of Cebu, Philippines under the name
AMOR __________, as evidence by my Certificate of Live Birth attached hereto
as Annex “A”;
2. I used the name as indicated in my Certificate of Live Birth as my official name
in all school and employment records;
3. ON ________________, I applied for a passport with the Department of Foreign
Affairs (DFA), Manila, Philippines and was issued one (No. ___________) under
the name ______________, attached hereto as Annex “B”;
4. The DFA omitted my middle name on the ground that I am an illegitimate child
who should only use the surname of my mother and not the latter’s middle name;
5. The name appearing in my Certificate of Live Birth and the passport above-
mentioned refer to one and the same person;
6. I am executing this affidavit to state on record as to the truth regarding the
discrepancies above-mentioned.
IN WITNESS WHEREOF, I have set my hand this, 24th day of August 2004, at
Makati City, Philippines.
______________________
Affiant
JURAT
SUBSCRIBED AND SWORN to before me, this 24th day of August 2004, affiant exhibiting his
Residence Certificate No. ___________ issued on ____________ at Makati City, Philippines.
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2004.