REPUBLIC OF THE PHILIPPINES]

CITY OF BACOLOD ] S.S.

x---------------------x

AFFIDAVIT OF ONE AND THE SAME PERSON

I, ________________, Filipino, single, of legal age, with address at

___________ after being duly sworn according to law, hereby depose and state that:

1. I am known by the name “___________________” and have used the same in

my personal and official records and interactions as shown by the following
government-issued identification card, a copy of which is attached hereto as
Annex “A”;

2. My name was recorded on the following as “___________________” in my Birth

Certificate registered with the Philippine Statistics Authority, a copy of which is
attached hereto as Annex “B”;

3. Both the names “____________________” and “______________________”

refer to one and the same person, the affiant.

4. I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I hereby affix my signature this _____________ at

___________________.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this _____________________ at

__________________, affiant personally appeared before me and exhibited her
government-issued identification card with number ______________ valid until
___________ bearing her photograph and signature.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.