REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.

City/Municipality of _____________)
x-----------------------x

AFFIDAVIT OF CHANGE NAME

I, LEE JUNG SO, Filipino, of legal age, single, and resident of Davao City, Philippines, having been
duly sworn in accordance with law, hereby depose and state:

1. That I was born on October 12, 1990 at Davao City to the Spouses Emilio and Emilita So;

2. That since I was young, I have always been known and called by the first name "LEE" and that
it is the same first name that I have been using in all my documents and identification papers;

3. However, it appears from the records of the Office of the Civil Registrar of Davao City that I
was registered with the name “Jung” only;

4. That it is my desire to be registered with the said Office of the Civil Registrar of Davao City
with the first name "LEE";

5. That the failure to state my first name was purely the inadvertence of my parents who failed
to do so because of their uncertainty at first as to what name would be given me at the time
of the registration of the facts of my birth with the said office;

6. As such, I execute this Affidavit to certify or attest to the truth of the foregoing facts and for
whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have set our hands this _____________, in the _____________,
Philippines.

AFFIANT

SUBSCRIBED AND SWORN to before me, this 10 December 2019, by the Affiant who is personally
known to me (or whom I have identified through competent evidence of identity) and who exhibited his/her
Community Tax Certificate No.800-300-1400 issued at Davao City on 13 June 2017.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.