REPUBLIC OF THE PHILIPPINES

Catbalogan City SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, Pfc Fred H Jakusalem, Filipino, of legal age, single, and with office address at
34th IB, Brgy Tambangan, Palapag Norther Samar under oath, state:

1. THAT my name appearing in my Pay Slip is “Pfc Fred H

Jarusalem” as shown by a copy of the said document hereto attached as
ANNEX “A”;

2. THAT however, I have been using the name “Pfc Fred H

Jakusalem,” a copy of the said documents using such name are hereto
attached as Annexes “B” and “C”;

4. THAT the name “Pfc Fred H Jarusalem” and “Pfc Fred H

Jakusalem” refer to one and the same person, the herein Affiant;

5. THAT I am executing this Affidavit to attest to the truthfulness

and veracity 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 05 March 2015 at

Camp Lukban, Maulong, Catbalogan City.

Pfc Fred H Jakusalem

Affiant

SUBSCRIBED AND SWORN to before me this 05 March 2015 at Camp Lukban,

Maulong Catbalogan City, Affiant exhibiting to me his AFP ID with ID No.
________________________ issued at ______________ on _________________.

PAUL AGERICO B AVILA

CPT JAGS (PA)
Administering Officer