AFFIDAVIT
I, ______________, of legal age, Filipino, single/married and a
resident of __________________, Philippines, after having been duly
sworn according to law depose and say:
That I am the petitioner seeking to correct a clerical error of
the Certificate of ______________________ of _____________________,
issued by the ______________________________.
That her name is currently recorded as “_________” on her
Certificate of ____________, which contains a clerical error.
That she was attended at birth by the “Paltera”,
________________ who resides at ____________________;
That her correct name is “_________________”.
That error in her name on the Certificate of ________ is due to
typographical error.
That I am the _______ of said person.
That I am attaching hereto, as part of this affidavit, the
following documents to support my claim of the correct name:
IN WITNESS WHEREOF, I have hereunto affixed my signature
this ______________
____________________
Affiant
SUBSCRIBED AND SWORN to before me this __________, at
______________, Philippines.
Doc No. _________
Page No. ________
Book No. ________
Series of 2025