(Affidavit of Discrepancy Date of Marriage of Parents)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

AFFIDAVIT OF DISCREPANCY

I, _____________, of legal age, Filipino, (single / married / widow), and a resident of

_____________, Philippines having been duly sworn in accordance with law, hereby depose
and state:

That I was born to the spouses _____________ and _____________ on

_____________ in _____________, Philippines as evidenced by the Certificate of
Live Birth issued by the City Civil Registrar of the City of _____________;

That however, in the said Certificate of Live Birth, the date of marriage of my parents
was erroneously written as "May 8, 1960" instead of the true and correct date "May
28, 1960" as evidenced by the Certificate of Marriage of my parents issued by the
City Civil Registrar of the City of _____________, hereto attached as Annex "A";

That said discrepancy in my Certificate of Live Birth was an error done inadvertently;

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

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

_____________, Philippines.

AFFIANT

(JURAT)