Affidavit of Discrepancy in Name

REPUBLIC OF THE PHILIPPINES)

Makati City ) SS.

AFFIDAVIT OF DISCREPANCY

IN NAME

I, _____________________, of legal age, married, and with address at

______________________________________________________, under oath, state:

1. THAT my name is ____________________ as stated and registered in my birth certificate issued by

office of the Civil Registry of ______________________. A copy of my birth certificate is hereto

attached as ANNEX “A”;

2. THAT the name ___________________also appears in my passport which was issued based on the

data appearing in my birth certificate. A copy of the page of my passport where my name and picture

appears is hereto attached as ANNEX “B”;

3. THAT since childhood, my friends and acquaintances call me________and thus since then I have been

accustomed to using the name ____________________in my personal records, transactions and

communications;

4. THAT the name ____________________ and _____________________ refer to one and the same

person, the herein Affiant;

5. 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 _________________ at Makati City.

________________________

Affiant
SUBSCRIBED AND SWORN to before me this _______________ at Makati City, Affiant exhibiting to

me his Passport bearing No. ______________________________ issued at ______________ on

_________________.

Doc No. ________;

Page No. _______ ;

Book No. _______;

Series of ________.