JOINT AFFIDAVIT OF ONE AND THE SAME PERSON

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF AKLAN )S.S.
MUNICIPALITY OF KALIBO )
X------------------------X

We, ____________________________________________, single, both of legal ages and

Filipinos citizens hereby jointly depose and say:

That we personally know ______________________________, the daughter

___________________________, ________________________ respectively for a long time;

That _______________________________ was born on September 19, 1991 at Old Buswang,

Kalibo, Aklan and such facts of birth were duly recorded before the Office of the Local Civil Registrar
of Kalibo, Aklan;

However, relative to the records of the Social Security System (SSS) No.
__________________, it appears thereon that her name is written as __________________ instead
of ________________________ her true and correct name;

That the name ______________________ appearing in all her records and other official
documents and ________________________ the name appearing Social Security System (SSS) No.
____________________, refers to one and the same person.

That such discrepancy in the entries was because of:

a. REASON

That we are executing this affidavit for the purpose of attesting to the truth of the above-
statements and for all legal purpose it may serve.

IN WITNESS WHEREOF, we hereto affixed our signatures October 24, 2018 at Kalibo, Aklan
Philippines.

Affiant Affiant

SUBSCRIBED AND SWORN to before me this October 24, 2018 in Kalibo, Aklan, personally
appeared ______________________________ with their Valid ID Cards indicated above below their
respective names, bearing their photograph and signatures, known to me as the same persons who
personally signed the foregoing instrument before me and avowed under penalty of law to the whole
truth of the contents of said instrument.

Doc. No. 54;

Page No. 12;
Book No. IX;
Series of 2018.