REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)
x---------------------------------------x
AFFIDAVIT OF DISCREPANCY ON NAME
I, ______________(name of affiant)__________________, Filipino,
of legal age, [single]/[married to ___________(name of
spouse)_______], and a resident of ___________(address of
affiant)____________, after having been duly sworn in accordance
with law, hereby depose and state:
1. That on _____(date)________, I was issued a Philippine
Passport with passport number _____________ in which my
true First Name _____(Correct Name)____ was stated;
2. That before the expiration of the aforementioned passport on
_____(date)________, I had applied with Philippine Embassy in
_____________ for the issuance of a new passport and on
_____(date)________,
4. I was issued a new Philippine passport with passport no.
_____________________;
5. However, in the said new passport my First Name had been
erroneously misspelled as _____(Misspelled Name)____;
4. That I execute this Affidavit of Discrepancy to attest to the
truth of the foregoing facts and to explain the discrepancy in my
Philippine Passport with regards my First Name.
IN WITNESS WHEREOF, I have hereunto set my hand this
_____________, at _____________, Philippines.
____________(signature)___________
Affiants Name

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________
20___. Affiant personally came and appeared with _____________(Competent
Evidence of Identity)______ issued by the _________(Government
Agency)______ on ___(date)__ at ________(place)_________, bearing his
photograph and signature, known to me as the same person who personally

signed the foregoing instrument before me and avowed under penalty of law to
the whole truth of the contents of said instrument.

Doc. No. ____

Page No. ____
Book No. ____
Series of 20__

[13upCD]

Atty ______________________________________
Notary Public
Commission Serial No. __________________
Notary Public for _______(Province/City)_____
Until December 31, 20__
Office: ______________(address)__________
Roll No. __________
IBP Lifetime Roll No. ________; __/__/__ ; (Province)
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__