REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)
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AFFIDAVIT OF DISCREPANCY ON NAME IN PASSPORT

I, _______________________________, Filipino, of legal age, [single]/[married to

_____________________________, and a resident of _____________________, after
having been duly sworn in accordance with law, hereby depose and state:

1. That on _____________, I was issued a Philippine Passport with

passport number _____________ in which my true First Name
______________________ was stated;

2. That before the expiration of the aforementioned passport on

_____________, I had applied with Philippine Embassy in _____________ for
the issuance of a new passport and on ____________,

4. I was issued a new Philippine passport with passport no.

_____________________;

5. However, in the said new passport my First Name had been

erroneously misspelled as __________________;

4. That I execute this Affidavit of Discrepancy to attest to the truth of the

foregoing facts and to explain the discrepancy in my Philippine Passport
with regards my First Name.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________,

at _____________, Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____________________ at

__________________________, Philippines. Affiant personally appeared exhibiting
to me his competent proof of identity as stated below his name.