Republic of the Philippines)

CITY OF ZAMBOANGA. . . . . ) S.S.

x- - - - - - - - - - - - - x

AFFIDAVIT OF DISCREPANCY

I, ______________, of legal age, single and residing at

___________, Zamboanga City, after having been sworn in accordance
with law, hereby depose and say:

That I am the legitimate son of the Spouses ____________ and

______________, having been born on ____________ in Zamboanga City,
Philippines;

That my birth was duly registered by my parents in the Civil

Registry of Zamboanga City as shown by my Certificate of Live Birth, a
copy of which is hereto attached as Annex “A”;

That in the said Certificate of Live Birth, my name is registered

as __________ instead of ___________, the latter being the name that I
have used in all my school and other official records;

That likewise in the said Certificate of Live Birth, the name of

my father is misspelled as __________ instead of _________, the latter
being the correct spelling of my and my father’s name;

That the names _______________ and ____________ all refer to me

as one and the same person;

That likewise, the names _____________ and _________________ all

refer to my father as one and the same person;

That I have already filed with the Office of the Civil Registrar
in Zamboanga City a petition for the correction of my name in my
Certificate of Live Birth from _________________ to ______________ to
conform with my academic and other official records;

That I am executing this affidavit to attest to the truth of the

foregoing narration of facts in order to establish the circumstances
surrounding the my birth, person, and identity in connection with my
request with the University Registrar of the Western Mindanao State
University to issue my Transcript of Records and other credentials
using the name ________________ and for all such other legal purposes
that this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands on this ____

day of ___________ in the City of Zamboanga, Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me, by the Affiants all of whom

are personally known to me, on this _______ day of ____________ in the
City of Zamboanga, Philippines.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2013