Republic of the Philippines )
City of Mocha ) S.S.
AFFIDAVIT OF CHANGE OF ADDRESS
I, SHALAMUKA DIMAPONDI, of legal age, a citizen of Malacca, single, and a resident of 52-A Sundam, Gandam Dormitory, Tanaka, Mocha City, after having been duly sworn to in accordance with the law, hereby depose and state – THAT:
1. I am an applicant for Student Visa Renewal/Extension;
2. That my current address is 52-A Sundam, Gandam Dormitory, Tanaka, Mocha City;
3. That I transferred to the said new address on February 2, 2018;
4. As proof of the foregoing, attached herewith is a copy of the Certification duly signed by Hon. Dundee Dobee, Barangay Captain of Barangay Tanaka, Mocha City, Philippines;
5. I execute this affidavit to attest to the truthfulness of the foregoing facts and in compliance with the requirement of the Bureau of Immigration for a change of address and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ________________ in Mocha City, Philippines.
SHALAMUKA DIMAPONDI
Affiant
SUBSCRIBED AND SWORN to before me, this _______________ by SHALAMUKA DIMAPONDI who exhibited to me his Barangay Certification of Residence and his Alien Certificate of Registration (ACR) Card No. 0000XXXX14344.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2021.
