Republic of the Philippines. . . .

)
------- . . . . . . .)
x - - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF TWO DIS-INTERESTED PERSONS

WE, -------, of legal ages, both married, Filipinos and residents of Brgy.
---------, having been duly sworn in accordance with law, hereby depose
and state:

1. That we personally know ------, because she is our neighbor and

long time friend;

2. That we are aware of an error committed in her SOCIAL SECURITY

SYSTEM (S.S.S.) as her middle name is only ------ but her full middle name is -
--------

3. That we know for a fact that her true and real middle -------”,
because for a long-long time we knew them in our community to be said
persons with their names;

4. That the names referred to above refer to one and the same
person;

5. That we are executing this Affidavit to attest to the truth of the

foregoing facts and for whatsoever purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this

Affiant Affiant

SUBSCRIBED AND SWORN to before me this 8th day of April, 2016 at

Dagupan city, Philippines.

Doc. No:______;
Page No:_____;
Book No:______;
Series of 2016.