Republic of the Philippines)

Quezon City ) S.S

AFFIDAVIT

I, ANNIE CABALLERO, of legal age, Filipino Citizen and a resident of #20 ST.
MICHAEL ST. CHARBEL EXECUTIVE VILLAGE MINDANAO AVENUE BRGY.
TANDANG SORA QUEZON CITY, after having been duly sworn to in accordance with law,
hereby depose and say:

1. That I was born on January 27, 1992 in Brgy. Malhacan, Meycauayan, Bulacan;

2. That I was enrolled in the Philippine Cultural High School and that for convenience
purposes, I was enrolled under the name HONG, XIAO TONG;

3. That the name I currently use and is registered as is ANNIE CABALLERO;

4. That I am executing this affidavit to attest to the veracity of my statements, in support for
my Visa Application and for whatever legal purpose it may serve;

IN WITNESS WHEREOF, I hereunto affix my signature this June 19th, 2023 at Quezon City.

ANNIE CABALLERO
Affiant

SUBSCRIBED AND SWORN to before me this June 19th, 2023, at Quezon City.

Doc No. ________;

Page No. ______ ;
Book No. _______;
Series of 2023