REPUBLIC OF THE PHILIPPINES) s.s.

CITY OF SURIGAO………………....)

AFFIDAVIT OF DISCREPANCY
I, NAME, of legal age, married, Filipino citizen, and a resident of ADDRESS,
Philippines, after having been duly sworn to in accordance with law, depose and
state, THAT:

1. I am the same person mentioned above who was issued a passport in

Department of Foreign affairs last 2015;
2. The said passport was lost and cannot be anymore found despite
diligent effort top locate the same;
3. In the said passport I erred in filling in that my citizenship is Filipino
“acquired by marriage”;
4. In truth and fact, my citizenship is “acquired by birth” not by
marriage;
5. I am executing this Affidavit of Discrepancy to attest to the truth of the
foregoing facts, to correct the erroneous entry of my citizenship in my passport and
for whatever legal purpose this instrument may be of use.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 25th day

of June, 2019 in Surigao City, Philippines.

Affiant

SUBSCRIBED AND SWORN, to before me this 25th day of June, 2019 at

Surigao City, Philippines. I Hereby Certify that I have personally examined the
affiant and that I am satisfied that she executed the foregoing facts freely and
voluntarily.