REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ILOILO ) S.S.

MUNICIPALITY OF TIGBAUAN )

AFFIDAVIT OF DISCREPANCY IN NAME

KNOW ALL MEN BY THESE PRESENT:

I, T, of legal age, married, a Filipino citizen, and a resident of Barangay Bitas,

Tigbauan, Iloilo, after having been duly sworn to in accordance with law, hereby
depose and state that:

1. My name is Tas stated and registered in my birth certificate issued by

the Office of the Municipal Local Civil Registrar of Tigbauan, Iloilo;

A copy of my birth certificate is hereby attached as Annex “A”;

2. My personal records, transactions, and communications are all under

the name T and no NT;

3. The name T and NTto one and the same person, the herein affiant;

4. I am executing this Affidavit to attest to the truth of the foregoing

statements and for whatever legal purposes and intents this may serve.

Signed on the date and at the place indicated below.

T
Affiant
Government Issued ID: __________________________

SUBSCRIBED AND SWORN TO before me on the date and at the place indicate
below. The affiant exhibited to me her competent evidence of identity as indicated above.

Signed this 23rd day of November 2019 at Tigbauan, Iloilo, Philippines.

WITNESS MY HAND AND SEAL

Doc. No. _________;

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