Republic of the Philippines )

City of Naga ) S.S.

AFFIDAVIT OF CHANGE OF STATUS

I, ________________, of legal age, married and a resident of _________________________, after having

been duly sworn in accordance with the law, hereby depose and state, THAT:

1. I am the same __________________, who is the affiant herein;

2. My civil status as appearing in the Contract to Sell and Deed of Assignment for the parcel of land located
at _________________________is single whereas my name appears as _________________, my
maiden name;

3. I am now married, hence my civil status in the Deed of Sale for the same parcel of land was stated as married
and name was changed to ________________ to reflect my change of status;

4. The change of status and name was made without intent of defrauding nor evading obligation which might
result to fraud to contracts;

5. I am executing this affidavit to attest to the truth of all the foregoing statements and for whatever legal
purpose this may serve,

IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of ______________, 2018 in the City
of __________________, Philippines.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ________________, 2018 in the City of
________________, Philippines, affiant exhibiting to me her ______________________ as her competent
evidence of identity.

NOTARY PUBLIC