AFFIDAVIT OF DISCREPANCY

IN NAME

REPUBLIC OF THE PHILIPPINES)

Dipolog City ) SS.

I, Arniel O. Saliga, of legal age, married, and with address at, under oath,do hereby
state and depose:

1. THAT I am the same Arniel O. Saliga which is my true and real name as registered
in my birth certificate issued by office of the Civil Registry of Ipil, Sibugay Province. A
copy of my birth certificate is hereto attached as ANNEX A is ARNIEL O. SALIGA.

2. THAT the name Arnel O. Saliga also appears specifically in my PHILHEALTH and
INSURANCE which is incorrect;

3. THAT since childhood, my friends and acquaintances call me Arniel, but I have
been accustomed to using the name called me Arniel in my personal records,
transactions and communications;

4. THAT the name Arniel O. Saliga and Arnel O. Saliga refer to one and the same
person, the herein Affiant;

5. THAT due to inadvertence and typographical error in the preparation of my

Philhealth ID and Insurance record, my true and real name was instead misspelled
and incorrect;

6. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to
use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this _________________ at

Dipolog City.

________________________

Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Dipolog City, Affiant

exhibiting to me his TIN Id No. 437795096 issued at Ipil, Sibugay Province on
_________________.

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Page No. ____;
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