AFFIDAVIT

I, _____, of legal age and a resident of _____, after having been deposed in
accordance with law, hereby depose and state that:

1. My true and correct legal name is _____, and that I was born on _____,.

2. I was baptized on _____, at the church of Our Lady of Mount Carmel

Parish, Project 6, Quezon City.

3. My name was erroneously registered in the Book of Baptism as

“_____,” instead of “_____,,” which is my true and correct legal name.

4. Likewise, my birth date was erroneously registered in the Book of

Baptism as “_____,” instead of “_____,” which is my true and correct birth date.

5. I further affirm that in all of my identification papers as well as

documents, legal or otherwise, I have always signed my name as “_____,” and I
have always stated my birth date as “_____.”

6. Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this

_________day of __________.

_____

SUBSCRIBED AND SWORN TO before me this _______ day of _________,

at ____________, affiant exhibiting to me her _____, issued on _____________ at
_______________.

WITNESS MY HAND AND SEAL on this __________ day of

______________, at ______________.

Doc. No. ________ ;

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