REPUBLIC OF THE PHILIPPINES)

Santiago City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, ROSALIE LUMANOG GOMEZ, of legal age, married, and with address at #88 Diamond
Street, Plaridel Subdivision, Santiago City, under oath, state:

1. THAT my name is ROSALY JOSUE LUMANOG as stated and registered in my

birth certificate issued by office of the Civil Registry of Tabuk City. A copy of my birth
certificate is hereto attached as ANNEX “A”;

2. THAT since childhood, my friends and acquaintances call me ROSALIE J.

LUMANOG and thus since then I have been accustomed to using the name ROSALIE J.
LUMANOG in my personal records, transactions and communications. A copy of my
employee’s Identification Card and government issued ID are hereto attached as ANNEX”B”;

3. THAT the name ROSALY LUMANOG and ROSALIE LUMANOG refer to one
and the same person, the herein Affiant;

4. THAT I am executing this Affidavit 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 ______ day of ___________ 2020 at
Santiago City.

ROSALIE LUMANOG GOMEZ

Affiant

SUBSCRIBED AND SWORN to before me this _______ day of ____________2020 at Santiago

City, Affiant exhibiting to me her valid ID issued at Santiago City.

Notary Public

Doc No. _________

Page No. ________
Book No. ________
Series of 2020