REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NORTHERN SAMAR ) S.S.

MUNICIPALITY OF CATARMAN )

AFFIDAVIT OF DISCREPANCY

I, ____________, of legal age, Filipino, married and resident of ________,

after having been sworn in accordance with the law herby depose and state
that:

1. I was born on ________ to Spouses _______ and _______, on _____

at ______ as evidenced by the certified true copy of my
Certificate of Live Birth which is hereto attached as Annex “A”;

2. Since I came into reason and up to the present, I have been

using the name ______ in all my personal and business
transactions, as well as in all of my school records and diplomas
from elementary up to college, my name was spelled as ______;

3. On ____ when I secured a copy of my birth certificate from the

National Statistics Office, I was surprised to learn for the first
time that my name therein was spelled as _____;

4. The names ________ and _______ refers to me, being one and the
same person;

5. I am executing this affidavit to attest to the truthfulness of the

foregoing statements and to establish the real identity of _______
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of

February 2018 at Siniloan, Laguna, Philippines.

S
Affiant

SUBSCRIBED AND SWORN to before me, this February ___, 2018, by

the Affiant whom I have identified through competent evidence of identity and
who exhibited his Community Tax Certificate No. _____ issued at ___ on
February 06, 2018.

NOTARY PUBLIC

Doc. No. ____

Page No. ____
Book No. ____
Series of _____