REPUBLIC OF THE PHILIPPINES )

Quezon City, Metro Manila ) S.S.

AFFIDAVIT OF CHANGE OF ADDRESS

I, ____________________________, of legal age, single, and a

resident of _____________, Quezon City, after having been duly sworn
to in accordance with law, hereby depose and state:

1. THAT I am the accused in Criminal Case No. _____________

pending before the Regional Trial Court, Branch _____,
Quezon City;

2. THAT the address indicated in the above Case Information is

_____________________________, Quezon City which is my new
and present address;

3. THAT however, all of my identification card (Social Security

System ID, Professional Driver’s License) indicated my old
address which is ________________________ Quezon City;

4. THAT _______________________ Quezon City is my new and

present address;

5. THAT all orders, notices and other court documents can be

mailed/served to my new address;

6. THAT, I am executing this Affidavit to attest to the truth of

the foregoing facts and to use the same for whatever legal
purpose it may serve.

Further, Affiant sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature this 16 th

day of June, ___________at Quezon City, Philippines.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______day of

______________2016 at Quezon City, Affiant exhibiting to me his Driver’s License
with No. _____________ issued by the Land Transportation Office and will
expire on _____________________.

Notary Public
Doc. No. : _______
Page No. : _______
Book No. : _______
Series of 2023