(Affidavit of Discrepancy - Date of Birth)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x
AFFIDAVIT OF DISCREPANCY
I, _____________, of legal age, (single / married / widow), Filipino and a
resident of _____________, Philippines, having been duly sworn in accordance
with law, hereby depose and state:
1. That in my Certificate of Live Birth as recorded in the Office of the
Civil Registrar of _____________ City, Philippines and Secondary
Student Permanent Record at _____________ High School, it is stated
that I was born on 21 May 1970 at _____________, Philippines;
2. That my relatives, acting on the honest belief that I was born on 21
May 1971, had used 21 May 1971 as my birth date in all pertinent
school records when they processed my enrollment at _____________
in _____________;
3. That when I filled up my voter's registration record required by the
Commission on Election last _____________, I had inadvertently and
erroneously written the date of my birth as 21 May 1971 instead of
21 May 1970;
4. That I am executing this Affidavit of Discrepancy to attest to the
truth of the foregoing facts and to explain the discrepancy in my
Certificates of Live Birth, Secondary Student Permanent Record,
Transcript of Records and Voter Registration Form as regards to my
date of birth;
5. Further, I am declaring that from this date hereon I would be using
my true and correct date of birth of 21 May 1970 in all my papers,
records and other documents.
IN WITNESS WHEREOF, I have hereunto
_____________, at _____________, Philippines.

set my hand this

AFFIANT
(JURAT)

SUBSCRIBED AND SWORN to before me, this _____________, by the Affiant who is
personally known to me (or whom I have identified through competent evidence of identity) and
who exhibited his/her Community Tax Certificate No. _____________ issued at _____________ on
_____________.
NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 20____.