Republic of the Philippines)

Rodriguez, Rizal) S.S

AFFIDAVIT
TO USE MAIDEN NAME

I, ELLEN A. ARCETA Filipino citizen, of legal age and presently

residing at Block 17 Lot 116, Phase 1-D Kasiglahan Village, San Jose,
Rodriguez, Rizal after having been duly sworn to in accordance with law,
hereby depose and say:

1. That I am married to ROBERTO T. VILLETA on August 18, 1987

in Majayjay, Laguna;

2. That I have opted not to use the surname of my husband since

the use of such will be in conflict with all my other documents;

3. That I have been using my maiden name in all of my

Identification Cards and all other government records;

4. That I am executing this Affidavit to attest to the truth of all the

above foregoing statements and for all legal intents and
purposes it may serve.

5.
IN WITNESS WHEREOF, I have hereunto sign this ______ day of
______________________ in Rodriguez, Rizal, Philippines.

ELLEN A. ARCETA
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of

_____________________ 20____ at Rodriguez, Rizal.

Doc. No. _____

Page No. ____
Book No. ____
Series of 2018