REPUBLIC OF THE PHILIPPINES }

} S.S.

AFFIDAVIT OF DISCREPANCY

I, HILARIO L. MIRANDA, of legal age, married, residing at 3295 San Martin St.,
San Jose, Angeles City after having been sworn to in accordance with law depose and
say that:

1. I was born on November 15, 1960 that evidence shows in my local Civil
Registrar of Angeles City (Civil Registry Form No. 1A, Birth-available)

2. That when my parents and relatives that my true date of birth is November
15, 1964, that my date of birth was erroneously entered in the record of the
Local Civil Registrar in Angeles City, is “NOVEMBER 15, 1962” contrary to
my true and correct date of birth which is “NOVEMBER 15, 1964”;

3. That the person named as LARRY L. MIRANDA who was born on

“NOVEMBER 15, 1962” in the record of the Local Civil Registrar of Angeles
City, and the person named LARRY L. MIRANDA who was born on
“NOVEMBER 15, 1964” attached Certificate of Live Birth, pertain to one and
the same person;

4. I am executing this Affidavit of Discrepancy to attest the foregoing.

In witness whereof, I affix my signature this day of at ________________-.

LARRY L. MIRANDA
Affiant

SUBSCRIBED AND SWORN TO on ___ day of _______ at ____________-,

affiant exhibiting to me his Identification No. _________________.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____
Series of 2019