Republic of the Philippines)

Angeles City, Pampanga ) S.S.

AFFIDAVIT OF DISCREPANCY

I, ADELINA MAGTOTO - SANTOS, of legal age, Filipino citizen, married and with postal
address at Block 7, Lot 15, New Jersey St., Timog Park Homes, Angeles City, after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I was born on 11 July 1968 as evidenced by my Certificate of Live Birth issued by the
National Statistics Office (NSO) and Philippine Passport issued by the Republic of the
Philippines-Department of Foreign Affairs (DFA), herein attached as Annex "A" and "B",
respectively;

2. That in the following documents:

a. Marriage Certificate (Annex "C")

b. Official Transcript of Record (TOR) - Bachelor's Degree in Nursing (Annex "D")
c. Official Transcript of Record (TOR) - Master's Degree in Nursing (Annex "E")
d. Philippine Regulation Commission (PRC) License - Registered Nurse (Annex "F")

it is indicated that I was born on 12 July 1968;

3. That my true and correct date of birth is 11 July 1968;

4. That date of birth (12 July 1968) indicated in the above-mentioned official documents is
erroneous and was a result of a typographical error;

5. That I am executing this affidavit to explain the discrepancy in the date of birth indicated
in my Certificate of Live Birth, Philippine Passport and Marriage Certificate, TORs and
PRC License;

6. That I am, further, declaring that from this date hereon, I would be using my true and
correct date of birth of 11 July 1968 in all my papers, records and other documents;

7. That I am executing this affidavit in support of my application for working permit in the
Kingdom of Saudi Arabia (KSA);

8. That I am executing this affidavit to attest to the truth of the foregoing and for other legal
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of May 2015 at Angeles
City, Pampanga.

ADELINA MAGTOTO - SANTOS

Affiant

SUBSCRIBED AND SWORN to before me this 25th day of May 2015 at Angeles City,
Pampanga, the affiant having been exhibited to me her Philippine Passport with No. EB3065443 valid
from 16 July 2011 to 15 July 2016, personally signed the foregoing instrument before me and
acknowledged to me that she freely and voluntarily executed the same.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2015.