Republic of the Philippines)

City of Las Piñas )s.s.

AFFIDAVIT OF
CHANGE OF HOME ADDRESS

I, MARILYN ROSALES FRANCISCO, Filipino, of legal age, and a

resident of No. 28 Julios Cmpd., Pulang Lupa 1, Las Piñas City, after having been
sworn in accordance with law, hereby depose and state that:

1. I am respectfully informing the MEDICAL CENTER IMUS regarding the

amendment and change of my home address from the above stated place:

To my present address:
Garnet St., DSM Subdivision Mambog I,
Bacoor City, Cavite
(Attached as Annex A, Barangay Certificate)

2. I transferred to my new residence last December 2016.

3. Undersigned Affiant, MARILYN ROSALES FRANCISCO is currently a

holder of Certificate of Firearms Registration for Individual, Firearms License Control
No. RBD-6425-51, valid until 31 January 2021.

4. I am executing this Affidavit of Change of Address in order to amend and

change my residence address.

AFFIANT FURTHER SAYETH NAUGHT,

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13 th day

of September 2021, in the City of Las Piñas, Philippines.

MARILYN ROSALES FRANCISCO

AFFIANT
UMID NO.: CRN-0111-6823381-4

SUBSCRIBED AND SWORN to before me in person on this 11th day of January

2018, at the City of Manila, Philippines, by MARILYN ROSALES FRANCISCO, who
is personally identified by me as such person after presenting to me her UMID No.: CRN-
0111-6823381-4, bearing her photograph and signature.

NOTARY PUBLIC

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2021.