REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LEYTE )
MUNICIPALITY OF Vxxxxxxxxx ) S.S.
x - - - - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF DISCREPANCY
I, xxxxxxxx, of legal age, Filipino, single and resident of Brgy. xxxxxx,
xxxxxxxxxxxxxxxx, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state:

1. That I am the father of xxxxxxxxxxxxxx, who was born on xxxxxxxxxxxxxx at

xxxxxxxxxxxxxxxx;

2. That in his Senior High Student Permanent Record issued by the Office of the
Villaba National Comprehensive High School, Villaba, Leyte, his name was erroneously written
as “xxxxxxxxxxxxx” instead of his true and correct name, that is, “xxxxxxxxxxxxxx” as what
is appearing in his Certificate of Live Birth issued by the Philippine Statistics Authority (PSA);

3. That the erroneous entry of his name in said Senior High Student Permanent
Record issued by the Office of the xxxxxxxxxxxxxx High School, xxxxxxxxxxxxxxxxxx was
purely because of my inadvertence and honest mistake in the filling up of the forms and
records of his Senior High Student Permanent Record with said school;

4. That I am executing this affidavit to attest to the truth of the foregoing statement
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of February, 2020,
at Villaba, Leyte, Philippines.

xxxxxxxxxxxxx
AFFIANT

SUBSCRIBED AND SWORN to before me, this 12th day of February, 2020, by the Affiant
who is personally known to me (or whom I have identified through competent evidence of
identity) and who exhibited his Drivers License ID Card No. xxxxxxxxxxxxxxxx issued at
xxxxxxxxxxxx, Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2020.