Republic of the Philippines,

Municipality of Tampakan,
South Cotabato) S.S.

AFFIDAVIT OF ONE AND THE SAME PERSON

I, , Filipino, of legal age, a resident of

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

1. I am known by the name “ ” as appearing in my Certificate

of Live Birth and have used the same in my personal and official records and
interactions, as shown by the following:
a. Certificate of Live Birth
b. PhilHealth ID with No.(other Valid ID)

Copies of which are hereto attached as Annexes “A-1” & “A-2”, respectively.

2. My name was recorded as “ ” with the Collective Certificates of Land

Ownership Awards (CCLOAs).

3. Both the names “ ” and “ ” refer

to one and the same person, the Affiant.

4. I am executing this Affidavit to attest to the truth of the foregoing and to support
my loan application and consolidation of membership records with the HDMF.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my signature this , in

.

_____________________
Affiant

Witness/es:

___________________ ______________________
Witness 1 Witness 2

SUBSCRIBED AND SWORN to before me, Affiant exhibiting her __________ ID with No.
, this , in .

Doc. No. ; NOTARY PUBLIC

Page No. ;
Book No.
; Series of 2023