Affidavit of Change Name

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Republic of the Philippines)

Bacolod City……………………..) S.S.

AFFIDAVIT
(LATE REGISTRATION OF MARRIAGE)

I, GLENN H. ARELLANO, of legal age, Filipino and a resident of Bacolod City, Negros
Occidental, Philippines, having been duly sworn in accordance with law, hereby depose and state
THAT:

1. I am the solemnizing officer and applicant for the late registration of marriage of
MARLON A. MANALO II and NICOLE MARIE D. LEDESMA.

2. The marriage was solemnized by the undersigned last 29 April 2018, at Punong
Gary’s Place in Silay City, Negros Occidental;

3. The marriage was solemnized in accordance with the customs and practices
allowed under the law/s imposed by the Family Code of the Philippines;

4. The Marriage has not yet been registered because it turned out that the Marriage
Certificate executed by both the husband and wife, including their witnesses have
erasures;

5. All informations and data stated in the Marriage Certificate are true and correct;

6. As such, I am executing this Affidavit to certify or attest to the truth of the foregoing
circumstances and for whatever legal purpose/s it may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature this _________________, in


Bacolod City, Philippines.

GLENN H. ARELLANO
Affiant
CEI: Tax Identification No. 973-933-875

SUBSCRIBED AND SWORN TO before me this __________________, at Bacolod City,


Philippines. Affiant exhibited to me his Competent Evidence of Identity (CEI) stated above.

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of 2018.

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