REPUBLIC OF THE PHILIPPINES )

Province of __________ ) S.S.

__________________ )

AFFIDAVIT of DISCREPANCY

I, XXX, of legal age, married, Filipino, and a resident of Barangay XXXX,

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

1. I was born on July 24, 1986 in Barangay XXXX;

2. The fact of my birth was duly registered with the Local Civil Registrar of XXX
under Local Civil Registrar No. XXX;
3. My true and correct middle name is XXX when I was still single which is the
maiden name of my mother and I have been using the middle name XXXX
since birth as evidenced by all of my personal and official documents;
4. However, my middle name is erroneously typed and entered into my
Certificate of Live Birth as B. instead of XXXX;
5. I have never used the middle name B. in any of my personal records and the
said error in my Certificate of Live Birth is most probably due only to
clerical/typographical error committed in the preparation/accomplishment of
the said document;
6. That I am voluntarily executing this affidavit to attest to the truth of all the
foregoing statements, to prove that my and my mother’s true and correct
middle name is XXXX and not B. as erroneously appearing in my Certificate
of Live Birth, to request for the correction of the said error in my Certificate of
Live Birth and for all legal intents and purposes this may serve.

IN TRUTH WHEREOF, I have hereunto affixed my signature this

________________________ in Science City of Munoz, Nueva Ecija.

XXXX
Affiant

SUBSCRIBED AND SWORN TO before me this _______________________

in _________________, affiant exhibiting to me her competent evidence of identity.

Doc. No._______
Page No._______
Book No._______
Series of 2020