Republic of the Philippines)

Antipolo City ) s.s.

AFFIDAVIT OF DISCREPANCY

I, SELFA REMPILLO REBANAL, of legal age, Filipino Citizen with

residence address at No. 73 Phase 3 Siruna Village Brgy. Mambugan Antipolo
City, after having been sworn in accordance with law, hereby depose and state that:

1. That in my Certificate of Live Birth my full name is:

SILFA REMPILLO REBANAL

(First Name) (Middle Name) (Last Name)

2. However, in all of my public documents, I am using my first name as

“SELFA” instead of “SILFA”.

3. That I am one and the same person as “SILFA REMPILLO REBANAL”

appearing in my Certificate of Live Birth and “SELFA REMPILLO REBANAL”
in all of my public documentas;

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing and in support of my application for tourist visa with the Japanese
Embassy.

IN WITNESS HEREOF, I affixed my signature this ___ day of January

2020 in Antipolo City.

SELFA REMPILLO REBANAL

SUBSCRIBED AND SWORN to before me, this ______ day of _______,inAntipolo

City, affiant exhibiting to me her PASSPORT ID NO. EC8366884 with expiry date
7-21-2021.

Doc. No.
Page No.
Book No.
Series of 2020