Affidavit of One and The Same Person

REPUBLI C OFTHE PHI LI PPI NES) Pr o vi nc eof_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )S. S. Ci t yof_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )  AFFI DAVI T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,o I ,_ fl e g alag e ,Fi l i pi no,s i ng l e /mar r i e d anda r esi dent of ______ ____ ____ ____ ____ ____ ___ ____ , af t er havi ng been dul y swornt oi naccor dancewi t hl aw,her ebydeposeandsayt hat :

1.Iwasbor n on __ __ __ __ __ __ __ __at_ __ __ __ __ __ __ __ _t oSpouses ___ __ ___ ___and __ ___ ___ __ ___ _,machi necopyofmyCer t i ficat e ofLi veBi r t hi ssued by t heNat i onalSt at i st i csOffice( NSO)i s her et oat t achedasAnnex“ A”andmadeani nt egr alparther eof ; 2.I n myschoolr ecor dsatt he__ __ __ __ __ __ __ __ __ __ __ __ ,myname me _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _”  was e r r oneous l yr ecor ded as “ ,i ns t e ad o f my t r ue and cor r ect name whi c h i s _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _” “ ; _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _” a _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _” r 3.The names “ nd “ e f e rt o oneandt hes ame meper son;

4.I .I am ex ec ut i ng t hi s Affidavi tt o at t es tt ot he t r ut h oft he f or eg oi ng f act s and t o r eq ue s tt he _ _ _ _ _ _ _ _ _ school _ _ _ _ _ _ r e g i s t r art oe ffe c tt hene c e s s ar yc o r r e c t i o ni nmys c ho olr e c o r ds .

I N WI TNESS WH WHEREOF OF,Iha v eher eunt osetmyhand t hi s __ __

dayof___ ____ __,2015i nQuezonCi t y ,Phi l i ppi nes.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  Affiant

SUBSCRI BED and SWORN t o bef or e me me, t hi s

_ _ _ _ day of __ __ __ __ _,2015,affi ffia antexhi bi t i ng t o mehi sI D wi t h number__ __ __ __  whi c hi sv al i dunt i l_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .

NOT OTARY PUBLI C

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