AFFIDAVIT FOR CHANGE OF ADDRESS

To: ___________________
______________________
______________________

REQUEST FOR AMENDMENT

RE: ___________________________
      
CITIZENSHIP:____________________

Dear Sir;

May I have the honor to request for the amendment of my home change of address

From: ___________________________________________________
To: ___________________________________________________

Please be informed that I moved from my place of residency. For this purpose, the undersigned
respectfully request for the amendment of his address to be printed to his ACR-1 CARD. I was a
holder of 13a Probationary/permanent Visa approved by the Board of Commissioners on
___________ valid until __________ with ACR-ICARD No.---------------- issued on------------- valid
until-------------. and we are continuously and harmoniously living with each other as husband and
wife up to the present.

Hoping that this letter request will merit your usual kind consideration and approval.

Very respectfully,

__________________________
   Signature over printed name
      ACR I-Card Holder

SUBSCRIBED AND SWORN TO BEFORE ME this ____________ day of ________ in the City of
Dumaguete. Affiant exhibited to me his _____ ___________ Issued on ________ at_______ valid
until_____________.

Doc. No. _____

Page No._____
Book No._____
Series of 2017.