Republic of the Philippines)

City of _______________ )s.s

x---------------------------------x

AFFIDAVIT OF ONE AND THE SAME PERSON

I, ______________________, of legal age, Filipino and a resident of Zamboanga

Del Norte, after having been duly sworn in accordance with law hereby depose and
say that;

1. That I am known by the name “______________________ ” and have used

the same in all my personal records, as evidenced by my valid identification
card;

2. However, in the list of beneficiaries of the Department of Social Welfare and

Development (DSWD) for the cash assistance for micro rice retailers, my
name was inadvertently recorded only as “_______________________”;

3. That the person appearing in my business records, valid identification card,

and the list of qualified beneficiaries are one and the same;

4. That the names __________________________ and

______________________ pertains to one and the same person; and

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

declaration and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ at

____________, Philippines.

________________________
Affiant
ID and ID No. Presented: ___________________

SUBCRIBED AND SWORN to before me this ___________ at

____________, Philippines.

Doc No. ____;

Page No. ____;
Book No. ____;
Series of 2023.