JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

WE, ______________________ and _____________________, both of legal age,

Filipinos, and with residence and postal address at __________________ and
____________________, respectively, after having been duly sworn to in accordance with
the law, do hereby depose and state:

1. That we personally know__________, of ________________since her childhood,

being long-time acquaintances and neighbours.

2. That we personally know that she was married to ____________and now carries
the family name ___________.

3. That unfortunately, when she enrolled for primary education, her name was
erroneously entered as “_____________”. She has been using this name ever
since and this appears in all of her education and employment records, as well as
in all her other documents.

4. That we likewise certify that ____________she has always indicated that she was
born at_____________, Philippines, on______________.

5. That she has been using the said birth date in all her documents and transactions

6. She requested for late birth registration in ____________wherein her birth

certificate indicated her name as “______________” and her birthdate
as______________.

7. That the names “______________as appearing in her birth certificate, passport

and latter employment records, and “______________” as appearing in all her
other records, refer to one and the same person;

8. That we are not related by affinity or consanguinity to the above- mentioned

person;

9. That we are executing this affidavit to support her request to have all her records
amended to reflect the name _______________with married name
_____________, the name appearing in her birth certificate and passport and
birth date be indicated as_____________.

10. That we are executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal intents and purposes it may deem serve.

IN WITNESS WHEREOF, We have hereunto set our hands this ___________at the City of
__________

___________________________ ___________________
Affiant Affiant

SUBCRIBED AND SWORN to before me, this _____ day of __________, at

______________________, affiants exhibiting to me competent evidence of identification:
NAME ID NO. DATE/PLACE OF ISSUE
Doc. No. __________; NOTARY PUBLIC
Page No.__________;
Book No.__________:
Series of 2017.