REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )

AFFIDAVIT OF DISCREPANCY

I, MADELYN CASIDO, of legal age, Filipino, single and a resident of Bais City,
Negros Oriental, having been duly sworn in accordance with law, do hereby depose and
state:

1. That I am the mother of James Mclyn Casido Sol who was born in August 23,
2019;

2. That sometime in August 25, 2019, my child was admitted to the hospital under the
name Baby Boy Casido;

3. That the father of my child is Jameson Q. Sol;

4. Considering that I am not married to the father of my child, I have used my maiden
name as the surname of the my child. However, the father has manifested his
intention to acknowledge his son and allowing him to use his surname;

5. With this, I am requesting the hospital to change the registration of my child’s name
from Baby Boy Casido or James Mclyn Casido to James Mclyn C. Sol;

6. That I am executing this Affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose this may serve.
7.

IN WITNESS WHEREOF, we have hereunto set our hands this 30th day of August
2019 in Dumaguete City, Philippines.

MADELYN CASIDO
Affiant
UMID 0111-8424125-0

SUBCRIBED AND SWORN TO before me this 30th day of August 2019 Philippines,
affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

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