Republic of the Philippines )

________ City, Metro Manila ) S.S.

AFFIDAVIT OF ONE AND

THE SAME PERSON

I, CCC, Jr., of legal age, single, Filipino citizen and a resident of

_______________________________, after having been duly sworn to in
accordance with law that:

1) I was born on ___________________ at __________________________

to AAA and BBB;

2) I am also known as _________________________ and as appearing

in Social Security System;

3) It was only after I went to the Social Security System to claim

my SSS Identification Card that I found out that the name
appearing in my SSS documents is CCC, without the Jr.;

4) CCC JR. and CCC refers to one and the same person;

5) That I have executed this Affidavit to attest to the truthfulness

of the foregoing facts and for whatever legal purpose this may
deem serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ in Quezon City, Philippines.

CCC, Jr.
Affiant