Republic of the Philippines)

CITYOF SAN PEDRO S.S

Province of Laguna
x-------------------------------------------x

AFFIDAVIT OF CHANGE OF ADDRESS

I, ELINOR Y. AMIL, of legal age, Filipino and with residential address at B15
L1 Uranus St. Ma. Aurora Brgy. Cuyab, City of San Pedro Laguna, after having duly
sworn to according to law hereby depose and state that:

1. I am a holder of an Alien Certificate of Registration (ACR) Card duly issued by the

Bureau of Immigration which reflects _____________________________ as my place of
residence;

2. However, I transferred my residence from ______________________ to

________________________________________________________________;

3. Presently, my new address is ___________________________________;

4. I have been living in my new address since ________________ up to present;

5. I am executing this affidavit to attest to the truth of the foregoing and to support my
application for change of address and/or to update the residence in my Alien Certificate
of Registration (ACR) Card at the Bureau of Immigration;

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

below, this 22nd day of August, 2022 at the City of San Pedro Laguna.

ELINOR Y. AMIL
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of August, 2022 in City of San
Pedro, Laguna. Affiant having exhibited to me his/her Voter’s ID with No. 3425-0086A-
C0876EYA20000 as competent proof of identity.

Doc. No: ________

Page No.:________
Book No.:________
Series of 2022