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Republic of the Philippines )

City of (Place) ) S.S


x-------------------x

AFFIDAVIT OF CHANGE OF ADDRESS

I, (Name of Affiant), of legal age, Filipino, single/married, and a resident of (Place of


Residence), after being sworn to in accordance with law, hereby depose and state that my
old residential address, to wit:

Old Address

(PLACE OF OLD ADDRESS)

Was on the (Date of Change of Address) changed to:

New Address

(PLACE OF NEW ADDRESS – UNDERLINE)

I am executing this Affidavit to attest to the truth of the foregoing and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this (Date)____________ in


(Place)________________, Philippines.

(NAME OF AFFIANT)
AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME this (Date) in the (Place), Philippines by


(Name of Affiant) who presented his Phil. Passport with No. (ID Number) which was
issued/expires on (Date) at (Place).

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of _____.

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