AFFIDAVIT OF RECONCILIATION OF BIRTH DATA

REPUBLIC OF THE PHILIPPINES )

_____________________________ ) SS.
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 say:
1. That I am the daughter of the couple and of and I was born on ;
2. That in the birth certificate which I obtained only recently, my family name is spelled as
"" instead of "" to which I have I have been used to as in my school records, SSS, BIR and
other public documents;
3. That a copy of said birth certificate which indicated my family name as "" is hereto
attached for reference;
4. That the names and belong to one and the same person, the undersigned herein;
5. That I am executing this affidavit in order to attest to the truth of foregoing
circumstances and for the purpose of setting the records straight and declaring
that and refer to one and the same person.
IN WITNESS WHEREOF, I have hereunto affixed my signature this day of 20_ at ,
Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _ this day of 20_.
The affiant, whom I identified through the following competent evidence of identity: (ID
type and number), valid from (date) to (date) issued by (issuing authority), personally
signed the foregoing instrument before me and avowed under penalty of law to the whole
truth of the contents of said instrument.
Notary Public

Doc. No. ........;

Page No. .......;

Book No. .......;

Series of 2010.
This affidavit is used to explain the discrepancy of the birth certificate against other
documents.