You are on page 1of 1

AFFIDAVIT

I, _________________, Filipino, single, of legal age, with address at


_________________, after having duly sworn in accordance with law,
hereby depose and say:

1. I was born on _________________ at _________________, Quezon


to Spouses _________________and _________________. My
Certificate of Live Birth is attached as Annex “A”.
2. Due to an error committed by one of parents in some of my
previous records, my name was and has always been recorded as
“_________________”. Proof thereof are attached as Annexes “B”
and “C”, respectively, which are my _________________ and
_________________.
3. However, as seen on my Certificate of Live Birth, which is attached
as Annex “A”, my complete and true name is
“_________________”.
4. Clearly, the names, “_________________” and
“_________________” refer to me, one and the same person.
5. I am executing this affidavit for whatever purpose it may serve
and and all other legal purposes. Further, I attest to the
truthfulness of the foregoing statements.

IN WITNESS WHEREOF, I affix my signature this __ day of


_____________ 2023 in _______________.

_________________
Affiant

[Notarization follows…]

You might also like