Republic of the Philippines] Santa Cruz, Laguna ] s.s.
I RENARIA REBONG MANDI, of legal age, Filipino, married and resident of Phase 1 Block 6 Lot 3, Opal Street, Lynville Homes, Bagumbayan, Santa Cruz, Laguna after having been sworn in accordance with law, hereby depose and state that – 1.
In the following documents and identification cards, the following names which refer to one and the same person (the undersigned), appear as follows – MANDI, RENARIA REBONG – Driver License No. D12-98-045891 Tax ID. No. (TIN) 291-406-759-000 Voter ID No. 3430-0020A-J1360RRM20001-7 3430-0020A-J1360RRM20001-7 REYNARIA P. REBONG – REYNA RIA PABALAN REBONG – Diploma (Elem./H.S./College) RENARIA PABALAN REBONG – Certificate of Live Birth
2.
Therefore, the correct maiden name of the undersigned is RENARIA PABALAN REBONG as appearing on her Certificate of Live Birth. The version RENARIA REBONG MANDI as currently in use by undersigned, is due to the fact of her marriage to Mendino J. Mandi, Jr. , on 21 April 2002. Those versions appearing in the school records of undersigned and in the SSS ID Card are honest clerical errors.
3.
Undersigned executed this affidavit to attest to the fact that the names appearing above refer to one and the same person, RENARIA REBONG MANDI.
IN WITNESS WHEREFORE, I hereto affixed my signature this 17 th day of September 2016 in Santa Cruz, Laguna.
RENARIA REBONG MANDI
Affiant SUBSCRIBED AND SWORN to before me this 17 th day of September 2016 by the affiant who exhibited to me her Driver License No. D12-98-045891 issued at LTO Pila District Office, Pila, Laguna, valid until 13 October 2015.
Doc. No. _____; Page No._____; Book No._____; Series of 2016.
ATTY. EMMANUEL E. SANDICHO
NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016 NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA PER NOTARIAL COMMISSION SP. PROC. NO. 164(15) BP O.R. No. 995689, 04 January 2016, Laguna Chapter PTR O.R. No. 2967138, 04 January 2016, Laguna Roll No. 42246, admitted to practice law on 9 May 1997 MCLE Compliance No. V-0015412, dated 9 March 2016