REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF MACABEBE ) S.S.

PROVINCE OF PAMPANGA )

AFFIDAVIT OF ONE AND THE SAME PERSON

I, xxx, of legal age, married, with address xxx, Philippines, and a Filipino, under oath, depose
and state:

1. THAT I am the ---- of ------;

2. THAT my mother’s real and correct name is ------ as stated in my Certificate of Live
Birth with Local Registry No. ---- issued by the Local Civil Registry of ------;
3. THAT in my Baptismal Certificate the name of my mother was inadvertently recorde,
instead of -----;
4. THAT the discrepancy in my Baptismal Certificate was just due to -----;
5. THAT ---- and ---- refer to one and the same person, which is my mother whose real and
correct name is ------;
6. THAT I intend to correct the said discrepancy in my ----;
7. I am executing this Affidavit to attest to the truth of the foregoing facts, and to use the
same for whatever legal purpose it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto affix my signature this --- at ----.

FULL NAME OF AFFIANT

Affiant

SUBSCRIBED AND SWORN to before me this XXX at XXXX, Affiant exhibiting to

me Postal ID No. ---- issued at Manila, Philippines valid until ----.

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NOTARY PUBLIC
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Doc No. ;
Page No.;
Book No. ;
Series of 2019.