REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.

MUNICIPALITY OF TAGO..)

AFFIDAVIT OF DISCREPANCY

I, MA. PSYCHE SALAZAR BELOY, Filipino, of legal age, and a

resident of Brgy. Dagocdoc, Tandag City, Surigao del Sur, after having
been duly sworn to in accordance with law, depose and state:

1. That I was born on December 06, 1975 to spouses Juan

Beloy and Natividad Salazar at Tandag City, Surigao del Sur as
evidenced by the certified true copy of my Certificate of Live Birth;

2. That I have been using the first name “Jeanette” spelled as

such in all of my school records from elementary up to secondary
education;

3. That when I secured a copy of my birth certificate from the

Philippine Statistics Authority, my first name therein was entered as
“Ma. Psyche” which is my true and correct first name;

4. That the names Jeanette Salazar Beloy in all of my school

records from elementary up to secondary education and Ma. Psyche
Salazar Beloy in my Certificate of Live Birth refer to one and the same
person;

5. I am executing this Affidavit of Discrepancy to attest to the

truth of the foregoing facts and for whatever legal purposes this may
serve.
IN WITNESS WHEREOF, we have hereunto affixed our
signatures this 24th day of June, 2019 at Tago, Surigao del Sur,
Philippines.

MA. PSYCHE SALAZAR BELOY

Affiant
SUBSCRIBED AND SWORN TO before me this 24th day of June,
2019 at Tago, Surigao del Sur, Philippines.
Doc. No. 30
Page No. 7
Book No. XV
Series of 2019