AFFIDAVIT TO ESTABLISH SINGLE IDENTITY OF NAMES

I, _________________________, of legal age, with postal address at

____________________________________________, after having been sworn to in accordance with
law, hereby depose and state:

1. That my name appearing in my Certificate of Live Birth issued by the Philipine Statistics Authority
(PSA) is ______________________, as shown by a copy of the said document hereto attached as
Annex “A”;
2. That however, I have used the name ___________________________ in our marriage certificate;
3. That the names _____________________ and __________________________ refer to one and
the same person, which is the undersigned/affiant herein;
4. That I am executing this affidavit to attest to the truthfulness and veracity of the foregoing and
for whatever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ______ 20___ in Marikina
City.

_____________________________
Affiant

Republic of the Philippines)S.S.

SUBSCRIBED AND SWORN to before me this ____th day of ______________ 20___ in Marikina City, with
affiant exhibiting to me his National ID with No. _________________ issued on the ____ day of February
20____, as his competent evidence of identity bearing his photograph and signature.

NOTARY PUBLIC
Doc No. ______;
Page No. _____;
Book No. _____;
Series of _____.