REPUBLIC OF THE PHILIPPINES)

PROVINCE OF) S.S.

MUNICIPALITY OF)
x--------------------------------------------x

AFFIDAVIT OF CHANGE OF FIRST NAME

I, , of legal age, Filipino, with residence and postal address at

CAANO, KALIBO, AKLAN, after having been duly sworn to in accordance
with law hereby depose and state that:

1. I am the Petitioner seeking the change of my first name in my Live

Certificate of Birth which is attached hereto as Annex “A;”;

2. I was born at Hospital in Kalibo, Aklan, Philippines;

3. My name as reflected in said document is Juan D. Marquez;

4. However, based on my Baptismal Certificate my name is reflected

as;

5. I am executing this affidavit to seek the change my first to

JUANCHO instead of JUAN;

6. I am filing this petition for the following reasons: I have assumed

the name Juancho in all my school records; I have habitually used
it as a child; I have been known among family members and
friends as Juancho; and my employment records also reflect my
first name as JUANCHO.

7. I am asking that the change be effected to avoid any confusion as

to my academic and employment records which my prejudice my
rights when I would to support any claim based such records;

8. I am submitting the following documents to support this petition:

(1) Affidavit of Two Disinterested Persons (Annexes “B” and “C”)

(2) School Records (Annexes “D,” “E” and “F”)
(3) Employment Records (Annexes “G” and “H”)
(4) Government Issued Identification Cards (Annexes “I” and “J”)
(5) (Other relevant documents may be included)

9. I have not filed any similar petition, to my best knowledge, no

other similar petition is pending with any Local Civil Registry
Office, any court in the Philippines or in any Philippine consulate
or embassy;

10. I have no pending criminal, civil or administrative case in any

court or quasi-judicial body; and
 11. I am filing this Petition in the Local Civil Registry of Quezon City
in accordance with R.A. No. 9046 and its Implementing Rules and
Regulations.

IN WITNESS WHEREOF, I hereby set my hand this 17th day of

June 2021 at Kalibo, Aklan, Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me this 17th day of June

2021, at Kalibo, Aklan by the above-named affiant, who has satisfactorily
proven to me his identity through his (ID, number and expiry date), to be
the same person who presented and personally signed before me this
(state name of document) and attested that the contents thereof are true
and correct; and that he voluntarily executed the same.

Doc. No. ______

Page No. _____
Book No. _____
Series of ______