REPUBLIC OF THE PHILIPPINES )
CITY)
AFFIDAVIT
RE: CHANGE OF CIVIL STATUS
I, ___________________________________, of legal age, married, Filipino citizens and a resident of
______________________________________________, after having been duly sworn in accordance with
law, hereby depose and say;
1. That I am the same owner of a motor vehicle with plate no. ___________ and more specifically
described as follows:
MAKE :
BODY TYPE :
MOTOR NO. :
CHASSIS NO.:
PLATE NO. :
MV FILE NO. :
2. That I am the same _____________________________ who is the affiant herein;
3. That my civil status appearing in my legal documents, particularly my Tax Identification Id is
SINGLE using my maiden name ________________________________;
4. That I am now presently married having been joined as husband and wife together with
________________________________ and a resident of
______________________________________________, and the fact of our marriage is
reflected in our Marriage Certificate from Civil Registry;
5. That I intend to change my name from _____________________________ which is reflected in
my issued ORCR for the aforesaid motor vehicle with Land Transportation Office to
_____________________________ to reflect my husband’s surname and signify my married
status;
6. That I have executed this affidavit to attest to the foregoing as facts, to inform the proper
authorities of such facts, so also, a new Certificate of Registration may be secured and for all
other legal intents and purposes.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _________ day of
______________ in _____________.
___________________
Affiant
SUBSCRIBED AND SWORN TO Before me this _________ day of ____________ in
__________________, Philippines affiant with ____________________.
Doc No. ____________ Notary Public
Page No. ____________
Book No. ____________
Series of 20