REPUBLIC OF THE PHILIPPINES)

______________________ ) SS.
_______________________ )
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AFFIDAVIT OF UNEMPLOYMENT

I, XXX, of legal age, Filipino, married, and a resident of ____________, after having
been duly sworn to on oath in accordance with law, hereby depose and state that:

1. That I am filing a petition for the correction/change of my first name in my Certificate of

Live Birth with the Local Civil Registrar of ___________.

2. That as of the moment, I am neither gainfully employed nor engaged in any form of
business and does not have any other source of income;

3. That I have not violated any Philippine Law of whatsoever kind and/or nature, neither is
there any case pending, civil, criminal and/or administrative against my person in any
court or tribunal nor I have been convicted of any crime in violation of any laws of the
Republic of the Philippines;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and to
support for my application for correction/change of my FIRST NAME in my Certificate
of Live Birth at the Local Civil Registrar of Bangar, La Union.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of June 2021 at
Balaoan, La Union, Philippines.

XXX
Affiant
Driver’s License No.: ________

SUBSCRIBED AND SWORN to before me this 7th day of June 2021 at Balaoan, La
Union. Affiant personally appeared before me.