REPUBLIC OF THE PHILIPPINES)

) S.S.
Quezon City )
x-----------------------x

AFFIDAVIT OF DISCREPANCY

I, _________________________, of legal age, Filipino, married, and a resident

of _________________________________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

1. That in my Certificate of Live Birth as recorded in the Office of the

Municipal Civil Registrar of ________________, Philippines, my
middle name was mistakenly not written;
2. That my true and correct middle name is “___________”, as
appearing in the same Certificate of Live Birth as the maiden name
of my mother;
3. Also, in my Certificate of Marriage as recorded in the Office of the
Civil Registrar of ________________, Philippines, my birthdate was
erroneously written as “__________________” instead of my true and
correct birthdate of “_________________”;
4. That my true and correct birthdate is “__________________”, as
appearing in the same Certificate of Live Birth as mentioned above;
5. That in all pertinent documents which I had used, to include that
of my scholastic records, I used my true and correct middle name
and birthdate of “_______________” and “_____________”, respectively;
6. Moreover, in the Certificate of Live Birth of my wife, as recorded in
the Office of the Municipal Civil Registrar of ________________, her
last name was misspelled to “____________” instead of
“____________”;
7. That the correct spelling of her last name is “______________” as
appearing in our Certificate of Marriage;
8. That I am executing this Affidavit of Discrepancy to attest to the
truth of the foregoing facts and to explain the discrepancy in my
Certificate of Live Birth and Certificate of Marriage, as regards my
true middle name, birthdate and correct spelling of my wife’s last
name.

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

________________ at ________________, Philippines.

_____________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______th day of

____________________ in ______________. Affiant exhibited to me his
___________________ as indicated above.

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