REPUBLIC OF THE PHILIPPINES)

CITY OF QUEZON ) S.S.

x--------------------------------------x

AFFIDAVIT OF DISCREPANCY

I, ANGELICA G. MARTIREZ, of legal age, Filipino, single and a resident of San

Francisco Del Monte, Quezon City, after having been duly sworn to in accordance with law,
depose and state THAT:

1. I was born on 10th day of the April 1987 to spouses Zenaida Galvez and Benjamin
Martirez;

2. I have been using the name ANGELICA G. MARTIREZ in all my documents,

transactions and Identification Cards;

3. However, when I obtained a copy of my birth certificate, I discovered that my surname

appearing thereon was erroneously written as "MARTEREZ";

4. The names “ANGELICA G. MARTIREZ ” and “ANGELICA G. MARTEREZ”

refers to one and the same person, the herein Affiant;

5. I execute this Affidavit of Discrepancy of Surname to attest to the truth of the

foregoing facts and to explain the discrepancy in my birth certificate with regards
my surname.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of April, in Quezon
City, Metro Manila, Philippines.

ANGELICA G. MARTIREZ
Affiant
UMID ID No. CRN – 0111-0674812-6

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence of
identity by way of __________________ issued at ______________ on __________________.

____________________________
NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.