Affidavit - Change of Marital Status

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REPUBLIC OF THE PHILIPPINES }

CITY OF MALOLOS, BULACAN } S.S.

AFFIDAVIT

I, _________________, of legal age, Filipino, married and residing at _______________


after having been duly sworn in accordance with law, hereby certify:

1. That I am presently employed as “Instructor – 1” in Bulacan State University (BSU)


Main Campus – Malolos, Bulacan;

2. That I am requesting the PRC, GSIS, PAG-IBIG, PHILHEALTH, BIR and other
agencies to change my name as appearing in their records, from ___________ to
____________ by reason of my marriage to _______________

3. That hereto attached is our CERTIFICATE OF MARRIAGE in order to prove that my


marriage with ________________ was solemnized last _____________ at Immaculate
Conception Parish – Cathedral & Minor Basilica, City of Malolos, Bulacan;

4. That I am now married, hence, my civil status in my records in the above-mentioned


agencies as well as to all other pertinent agencies should be changed from SINGLE to
MARRIED

5. That the change of status and name was made without intent of defrauding nor evading
any obligations under the law;

6. That I have executed this affidavit to attest and confirm the truth of all the foregoing and
to be used for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in


the City of Malolos, Bulacan.

________________
Affiant
___________

SUBSCRIBED AND SWORN TO before me this ___________________ in the City of


Malolos, Bulacan.

Doc. No.________
Page No. _______
Book No. _______
Series of 2021.

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