REPUBLIC OF THE PHILIPPINES)

San Pablo City, Laguna Philippines )

AFFIDAVIT OF DISCREPANCY
I, _________, of legal age, married, and with address at ________________,
Philippines, subscribing under oath, state that

1. That I am the mother of ____________________.

2. That the true and lawful name of my daughter is _____________________ as

indicated in her Certificate of Live Birth issued by Office of the Civil
Registrar. Attached hereto is the copy of Certificate of Live Birth as Annex
“A”.

3. That in the purchased airplane ticket in _____________ her name was

entered as __________________ instead of ____________________.
Attached hereto is the copy of airplane ticket as Annex “B”

4. I would like to manifest that my daughter lawful name is

_____________________.

5. That ________________ and ___________________, refers to one and the

same person.

6. I am executing this Affidavit of Discrepancy to attest to the truth of the

foregoing facts and to use the same for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I hereunto affix my signature this __________ at

____________________

__________________
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in ____________,
personally appeared at _____________, with ID no: _____________ issued by
_________, the same bearing affiant's photograph and signature, and who attested
that she is the same person who personally signed before me the foregoing document
and acknowledged that she executed the same.

Doc No: ___________

Page No: __________

Book No: __________

Series of __________