PETITION FOR CHANGE OF NAME

Republic of the Philippines

OFFICE OF THE CITY/MUNICIPAL CIVI L REGISTRAR
Province: Capiz
City/Municipality:Roxas City

Republic of the Philippines)

Province of Capiz) SS
Roxas City) Petition No. ______________

PETITION

I Mr. Kyrie Irving of legal aged , resided at Lawa-an, Roxas City, Do hereby solemnly affirm
and sate a follows:
1. That my recorded name in school and college is _________(Kyrie Irving), but I myself
popularly known as _________________(Kalye Irving).
2. That after the completion of my studies I want to start a business in IT Sector. From the
numerology point of view; I came to a conclusion that the business in my nickname as in the
name of NICKNAME will helpful for my endeavours.
3. That by virtue of this affidavit, I changed my name from YOURNAME (Kyrie Iring) to
CHOSENNAME (Kalye Irving) and henceforth I shall be known as the CHOSENNAME (Kalye
Irving) for all purposes.
4. That the facts stated above are true to the best of my knowledge and belief.

Identified by:

Kevin Love

Advocate Deponent

VERIFICATION
I, Kevin Love, the petitioner, hereby certify that the allegations herein are true and correct to
the best of my knowledge and belief.

Place: Roxas Avenue, Roxas City, Capiz

Date: 10 November 2015

 Kevin Love

JURAT

SUBSCRIBED and SWORN TO before me this 10 th day of November 2015 at Roxas

City, Philippines, affiant exhibiting to me his TIN Card ID No. 000-345-458-780 issued by the
Bureau Internal Revenue, as competent evidence of his identity, and he personally acknowledged
to me that the foregoing Petition is his free and voluntary act and deed. Machine copy of this
TIN Card ID is hereto attached.

Atty. Lebron James

NOTARY PUBLIC
PTR No. 12345, Roxas City, 1/2/11
IBP OR No. 8576379, Roxas City, 1/2/11
Attorneys Roll No. 555666
MCLE Compliance Certificate No.IV-0000032,
Roxas City, 1/2/15

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