You are on page 1of 1

REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )S.S.


City of Dumaguete )
x------------------------x

AFFIDAVIT OF DISCREPANCY

I, ISABELO B. ATOWAN, JR. of legal age, Filipino, married, and a resident of


Magatas, Sibulan, Negros Oriental, Philippines, having been duly sworn in accordance
with law, hereby depose and state:

That in my Certificate of Live Birth as recorded in the Office of the Civil


Registrar of Manukan, Zamboanga Del Norte, Philippines, my middle
name was erroneously missed out instead of having my true and correct
middle name of "BELLINGAN";

That my true middle name is "BELLINGAN" as appearing in the same


Certificate of Live as the maiden name of my mother.

That in all pertinent documents which I had used, to include that of my


scholastic records (transcript of records), marriage contract, I used my
true and correct middle name of "BELLINGAN";

That I am executing this Affidavit of Discrepancy to attest to the truth of the


foregoing facts and to explain the discrepancy in my Certificates of
Live Birth, as regards my true middle name.

IN WITNESS WHEREOF, I have hereunto set my hand this 02 day of October,


2019 at Dumaguete City, Philippines.

ISABELO B. ATOWAN JR.


Affiant

SUBCRIBED AND SWORN TO before me this 02 day of October, 2017 at Dumaguete


City, Philippines, affiant exhibiting to me his valid proof of identification his Drivers
License ID with No. G02-04-001928, which is valid until 2024/04/28.

Doc. No. _____;


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

You might also like