Republic of the Philippines)

)s.s

AFFIDAVIT
RE: CHANGE OF CIVIL STATUS

I, DIANNE KRISTINE C. GEORGE-MORENO , of legal age, married,

Filipino and a resident of Unit 7F Molave Tower, Suntrust Parkview Natividad
Lopez St., Ermita, Manila, after having been duly sworn in accordance with law
do hereby depose and say:

1. That I am the same DIANNE KRISTINE C. GEORGE who is the

affiant herein;

2. That my civil status appearing in the my records with the Social

Security System (SSS), Home Development Mutual Fund (Pag-Ibig),
Commission on Election (Comelec) Philippine Health Insurance
Commission (PhilHealth) and Professional Regulation Commission
(PRC) is SINGLE whereas, my name appears as DIANNE KRISTINE
C. GEORGE, my maiden name;

3. That I am now married, hence, my civil status in my records with the

Social Security System (SSS), Home Development Mutual Fund (Pag-
Ibig), Commission on Election (Comelec) Philippine Health Insurance
Commission (PhilHealth) and Professional Regulation Commission
(PRC) should be changed from SINGLE to MARRIED and my name
from DIANNE KRISTINE C. GEORGE to DIANNE KRISTINE C.
GEORGE-MORENO;

4. That this change of status and name was made without intent of
defrauding nor evade obligation which might result to fraud to
contracts;

5. That I am executing this affidavit to attest to the truth of all the

foregoing statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of

_______________ 2018 at _______________, Philippines.

DIANNE KRISTINE C. GEORGE- MORENO

Affiant

SUBSCRIBED AND SWORN to before me this __ day of ______________

2018 at _________________, Philippines.

Doc. No. ___

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