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Republic of the Philippines )

City of -- ) S.S.

AFFIDAVIT

I, --, 52 years old, married, Filipino, and resident of -- after having been
duly sworn to an oath in accordance with the law, hereby depose and
say:

1. That the name indicated in my Certificate of Live Birth is --;

2. That I grew up consistently using the name --, as that appearing in


my identification cards and other records;

3. That my TRUE AND CORRECT NAME is --;

4. That the name -- and -- refers to one and the same person;

5. That I am executing this Affidavit to attest to the truthfulness of


the facts of the above-mentioned matters and for any or all legal
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


13 day of July 2023 in --.
th

--
Affiant

SUBSCRIBED AND SWORN TO before me this 13th of July 2023 in


--, affiants exhibiting his valid Government-issued ID for identification.

WARNING:
TAMPERING WITH THIS PUBLIC DOCUMENT IS A CRIMINAL OFFENSE

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