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  • Affidavit of Reconciliation

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    Jim Ross executed an affidavit to reconcile a discrepancy between his birth certificate and other identification documents. His birth certificate listed his last name as "Russ" instead of his actual last name of "Ross", which is how it appears on his school records, SSS, BIR, and other public documents. Through this affidavit, Jim Ross aims to attest that "Jim Russ" and "Jim Ross" refer to the same person in order to correct the records.

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    AFFIDAVIT OF RECONCILIATION.doc

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    Jim Ross executed an affidavit to reconcile a discrepancy between his birth certificate and other identification documents. His birth certificate listed his last name as "Russ" instead of his actual last name of "Ross", which is how it appears on his school records, SSS, BIR, and other public documents. Through this affidavit, Jim Ross aims to attest that "Jim Russ" and "Jim Ross" refer to the same person in order to correct the records.

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    © All Rights Reserved
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    51 views1 page

    Affidavit of Reconciliation

    Uploaded by

    Jong
    Jim Ross executed an affidavit to reconcile a discrepancy between his birth certificate and other identification documents. His birth certificate listed his last name as "Russ" instead of his actual last name of "Ross", which is how it appears on his school records, SSS, BIR, and other public documents. Through this affidavit, Jim Ross aims to attest that "Jim Russ" and "Jim Ross" refer to the same person in order to correct the records.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 1

    REPUBLIC OF THE PHILIPPINES )

    CITY OF MANILA ) S.S.

    AFFIDAVIT OF RECONCILIATION
    OF BIRTH DATA

    I, JIM ROSS, of legal age, single, and residing at ____________, after


    having been duly sworn to according to law, hereby depose and state:

    1. That I am the son of the couple MARIZEN ESTERON and NEP ROSS
    of Baguio City and I was born on December 21, 1986;

    2. That in the birth certificate which I obtained only recently, my


    family name is spelled as “Russ” instead of “Ross” to which I have been used
    to as in my school records, SSS, BIR and other public documents;

    3. That a copy of said birth certificate which indicated my family name


    as “Russ” is hereto attached for reference;

    4. That the names Jim Russ and Jim Ross belong to one and the same
    person, the undersigned herein;

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


    the foregoing circumstances and for purposes of setting the records straight
    and declaring that Jim Russ and Jim Ross refer to one and the same person.

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


    _____, 2014, in the City of Manila, Philippines.

    _______________
    Signature of Affiant

    SUBSCRIBED and sworn to before me, this 30 th day of October 2013


    by ________________ who exhibited to me (his/her) GSIS UMID Card
    issued at__________, Philippines.

    Doc. No. ______;


    Page No. ______;
    Book No, ______;
    Series of 2014

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