Republic of the Philippines )

City of Mocha ) S.S.

AFFIDAVIT OF CHANGE OF ADDRESS

I, SHALAMUKA DIMAPONDI, of legal age, a citizen of Malacca, single,

and a resident of 52-A Sundam, Gandam Dormitory, Tanaka, Mocha City, after
having been duly sworn to in accordance with the law, hereby depose and state
– THAT:

1. I am an applicant for Student Visa Renewal/Extension;

2. That my current address is 52-A Sundam, Gandam Dormitory, Tanaka,

Mocha City;

3. That I transferred to the said new address on February 2, 2018;

4. As proof of the foregoing, attached herewith is a copy of the Certification

duly signed by Hon. Dundee Dobee, Barangay Captain of Barangay Tanaka,
Mocha City, Philippines;

5. I execute this affidavit to attest to the truthfulness of the foregoing facts

and in compliance with the requirement of the Bureau of Immigration for a
change of address and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

________________ in Mocha City, Philippines.

SHALAMUKA DIMAPONDI
Affiant

SUBSCRIBED AND SWORN to before me, this _______________ by

SHALAMUKA DIMAPONDI who exhibited to me his Barangay Certification of
Residence and his Alien Certificate of Registration (ACR) Card No.
0000XXXX14344.

Doc. No. _____;

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