REPUBLIC OF THE PHILIPPINES )

Municipality / City of ________________) S.S.

AFFIDAVIT OF ONE AND THE SAME PERSON

I, ______________, Filipino, of legal age, with address at

_______________________, after having been sworn in accordance with law, hereby
depose and state that:

1. My name, as appearing in my Passport ID, is “JUANO DELA CRUZ.”

2. My name, as appearing in my Driver’s License, is “JUANCHO DELA CRUZ.”

3.0. The names “JUANO DELA CRUZ” and “JUANCHO DELA CRUZ”
belong to one and the same person, the undersigned herein.

4.0. I am executing this affidavit in order to attest to the truth of the foregoing
matters, for setting the records straight, and for whatever legal purpose it may serve.

___________________ City, __________, 20____.

____________________
Affiant

SUBSCRIBED AND SWORN to before me this __________________________ at

_________________________ affiant presenting to me his competent evidence of identity
by way of the following:

NAME ID with No. issued on and valid until

Doc. No.: ___________

Page No.:___________
Book No.:___________
Series of 20___