REPUBLIC OF THE PHILIPPINES)

) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, MARY JORIE PALMA SICAT, of legal age, single, and with address at
No 1431 Algeciras Street, Sampaloc, City of Manila, Philippines, under oath,
state:

1. THAT I am the mother of JEWEL DELEON PALMA as stated and

registered in her birth certificate by the Office of the Civil Registry
of the City of Manila. A copy of my daughter’s birth certificate is
hereto attached as ANNEX “A”;

2. THAT since my daughter’s childhood, her friends and

acquaintances call her JEWEL PALMA and thus since then she has
been accustomed to using the name JEWEL PALMA in her
personal records, transactions and communications including that
of the Hospital Records in Infant Jesus Hospital;

3. THAT the name JEWEL DELEON PALMA and JEWEL PALMA

refer to one and the same person;

4. 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 12th day

of December 2018 at City of Manila.

MARY JORIE PALMA SICAT

Affiant

SUBSCRIBED AND SWORN to before me this _____day of

December 2018 at ________________, Affiant exhibiting to me her
_________________________ issued at _____________ on ________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.