REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

AFFIDAVIT OF ONE
AND THE SAME PERSON

I, xxx, with residence at xxx, after having been sworn in accordance

with law, do hereby depose and state:

1. I am a Filipino citizen born in xxx;

2. My first name is xxx, as evidenced by my Certificate of Live Birth, a

copy of which is attached hereto as “Annex A”;

 LAST NAME: xxx

 FIRST NAME: xxx
 MIDDLE NAME: xxx

3. After marriage, I adopted the last name of my husband, and used

the name xxx as evidenced by our Marriage Certificate, a copy of
which is attached hereto as “Annex B”;

4. That I have openly, notoriously and continuously used the nickname

“xxx”, and that I am known to be the same person under the name
“xxx”;

4. That my Land Transportation Office driver’s license with No.

CRN.006-0006-7086-1 is under my nickname “xxx”, instead of my
birthname, “xxx”. A copy of my driver’s license is attached hereto as
“Annex C”;

5. I hereby attest to the fact that the person by the name of “xxx”
appearing in some documents and records, or specifically in my
Certificate of Live Birth, and the name “xxx” as appearing in my
Driver’s License, refer to one and the same person and that her true
and correct name is xxx;

6. As such, we execute this Affidavit or attest to the truth of the

foregoing facts and for whatever legal purpose that this Affidavit may
serve.

IN WITNESS WHEREOF, this affidavit has been signed on this _____ day of
________________ 2019 in Makati, City.

xxx
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REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

BEFORE ME, a Notary Public and in Makati City, on this ___ day of
_______ 2019, personally appeared MARIA xxx, exhibiting her Passport No.
__________________, valid until __________________ at
____________________. Known to me to be the same person who executed
the foregoing Affidavit, and she acknowledged to me that the same is her free
and voluntary act and deed.

Witness my hand and seal this ______ day of ____________ 2019.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2019.