Republic of the Philippines )

Cainta, Rizal ) SS.

AFFIDAVIT OF DISCREPANCY

I, __________________, Filipino, of legal age, single and a resident of

_______________________________________, under oath, do hereby depose and state,
that:

I was born of the SPOUSES __________________ and ___________________ on

____________________ in _____________________, where I was named
___________________________. A copy of my Certificate of Live Birth issued by the
National Statistics Office (currently known as Philippine Statistics Authority) under
Registry No. ____________ is hereto attached as Annex “A” and made an integral part
hereof;

It so happened, however, when I obtained a copy of my ___________________

duly issued by _____________________, I found out that my birthdate was erroneously
registered as ________________ when in truth and in fact is ___________________;

The said discrepancy was due to typographical error and unintentional on my part;

This affidavit is being executed to attest to the veracity of the foregoing statements
in order to establish the fact that _______________________ with birthdate of
________________ and ____________________ with birthdate of
__________________, REFERS TO ONE AND THE SAME PERSON, and that the
latter is my true and correct date of birth, for purposes not contrary to law, morals, good
custom and public policy.

IN WITNESS WHEREOF, I have hereunto set on my hands and respective

signatures this _______________________ at Cainta, Rizal.

___________________________
ID No.
Issued by
Affiant

SUBSCRIBED AND SWORN TO before me on the date and at the place above-
written.

NOTARY PUBLIC
Doc. No. ;
Page No. ;
Book No. ;
Series of 2019.