Republic of the Philippines )

City of Cebu ) S.S.

PERSONAL AFFIDAVIT

I, __________________, of legal age, married and with address at Paculob,

Dumanjug, Cebu under oath, state:

1. THAT in my Certificate of Live Birth issued by the Philippine Statistics

Authority and Office of the Local Civil Registrar of Municipality of
Dumanjug, Philippines, my middle name was not stated on the record;

2. THAT I have used ________________ as my middle name when I was

still single;

3. THAT when I filled up my application form for the September 2022

Licensure Examination for Teachers (LET) before the Philippine
Regulation Commission, I was informed that I have to make this affidavit
for purposes of the examination;

4. THAT I am executing this Affidavit to attest to the truth of the foregoing

facts and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 30 th day of

June 2022 in City of Cebu, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this 30 th day of June 2022 in

Cebu City. Affiant exhibiting to me her ____________issued in Municipality of
Dumanjug, Cebu.

Doc No. ________;

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