PAO FORM No.

2010-4
AFFIDAVITS

REPUBLIC OF THE PHILIPPINES)

MANILA ) Ss.

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

WE, and both of legal ages,

Filipino and with residence addresses at and ,

respectively, after having been jointly sworn to in accordance with law do hereby depose and state,
that:

1. We personally know the person of who was born on

at to the spouses and

;

2. It was discovered lately that his/her NAME / MIDDLE NAME / FAMILY NAME / DATE OF
BIRTH / PLACE OF BIRTH, , was erroneously entered as
in his/her (document);

3. The true and correct NAME / MIDDLE NAME / FAMILY NAME / DATE OF
BIRTH/PLACE OF BIRTH is/are ;

4. and refer to one and the same

person;

5. That we are executing this affidavit to attest to the foregoing narration of facts and for
whatever legal purposes and intents this may serve.

IN TESTIMONY WHEREOF, WE have hereunto affixed our signatures this day of

at , Philippines.

Affiant Affiant
Com. Tax Cert. No. Com. Tax Cert. No.
Issued on Issued on
Issued at Issued at_
 SUBSCRIBED AND SWORN to before me this day
of , at Manila, Philippines. The identities of the affiants are
established by their respective Philippine Passports
Nos. and , issued on .

NAME OF PUBLIC ATTORNEY

Public
Attorney
(Pursuant
to R.A.
9406)