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    Affidavit of Reconciliation of Birth Data


    Republic of the Philippines )
    Province of ________________ ) SS.
    City/Municipality of _______ ) 
    x- - - - - - - - - - - - - - - - - - - - - x


    AFFIDAVIT OF RECONCILIATION OF BIRTH DATA



    I, _______________________________, of legal age, single, Filipino citizen, and with residence at ___________________________ after having been sworn in accordance with law, do hereby depose and state that:

    1. I was born to Spouses _______ and _________ of Calbayog City on May 10, 1976;

    2. In the birth certificate which I obtained only recently, my family name is spelled as "________________" instead of "_________________" to which I have I have been used to as in my school records, SSS, BIR and other public documents. A copy of said birth certificate which indicated my family name as "_______________" is hereto attached for reference;

    3.   The names _________________ and ___________________ belong to one and the same person, the undersigned herein;

    4. That I am executing this affidavit in order to attest to the truth of foregoing circumstances and for the purpose of setting the records straight and declaring that ____________________ and _________________________ refer to one and the same person.

    IN WITNESS WHEREOF, I have hereunto affixed my signature on this _________ day of ______________, 20 ______  in _______________________.



    _______________________________
    Affiant


    SUBSCRIBED AND SWORN TO before me this _____ day of _________ at ________________ affiant exhibited to his/her competent evidence of identity by way of _________________ issued on __________________ in _______________, Philippines.


    Doc. No. _____
    Page No. _____
    Book No. _____
    Series of 2016.


    NOTARY PUBLIC

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