Republic of the Philippines )

City of (Place) ) S.S.

AFFIDAVIT OF DISCREPANCY
I, (NAME OF AFFIANT), Filipino, of legal age, single/married, with postal address
at (Place of Residence), after having been sworn to in accordance with law, hereby depose and
state:

1. That in my Certificate of Birth, my middle name was erroneously written as "(ERRONEOUS

NAME)" instead of my true and correct middle name of "(CORRECT NAME)"

2. That my true middle name is "(CORRECT NAME)"; as appearing in my (Government-Issued

ID-1) and (Government-Issued ID-2), a copy of which are hereto attached as Annex “A”;

3. That in all pertinent documents which I had used, to include that of my Election Records and GSIS
Records, I used my true and correct middle name of "(CORRECT NAME)"

4. 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, as regards my true middle name.

5. That I assumed the name (NAME OF AFFIANT), when I signed official documents and
exercised my professional work in government;

6. That the names (ERRONEOUS NAME), as appearing in my Philippine Passport of (Years of

Passport Validity), and (CORRECT NAME), as appearing in my government-issued IDs, refer
to one and the same person, which is the undersigned/affiant herein;

7. That I am executing this Affidavit to clear any discrepancy which may arise from official
documents bearing either name “(ERRONEOUS NAME)" or “(CORRECT NAME)”.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (Date) in (Place).

NAME OF AFFIANT
Affiant

SUBSCRIBED AND SWORN to before me this (Date) in (Place), with affiant exhibiting
to me his (ID Details).

Doc. No. ____;

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