REPUBLIC OF THE PHILIPPINES)

City of San Carlos ) SS.

Province of Negros Occidental

AFFIDAVIT OF DISCREPANCY IN NAME

I, CRESENCIO VESCA ALQUIZAR, of legal age, married, Filipino and with an address
at Sitio Tunga, Brgy. Palampas, San Carlos City, Negros Occidental, Philippines, under
oath, state:

1. THAT, I am a member of the Social Security System (SSS);

2. THAT, the person named “CRESENCIO VILLA ALQUISAL in the personal

Data Record of SSS and the person named “CRESENCIO VESCA
ALQUIZAR.” in the Local Civil Registrar are ONE AND THE SAME
PERSON; (Attached is the Birth Certificate of CRESENCIO VESCA
ALQUIZAR)

3. THAT, the REAL AND CORRECT full name of the affiant is CRESENCIO
VESCA ALQUIZAR;

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

facts, for the application of SSS benefits and to use the same for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 30th day of June 2020 at
San Carlos City, Negros Occidental, Philippines.

CRESENCIO VESCA ALQUIZAR

Affiant
Senior Citizen ID._____________

SUBSCRIBED AND SWORN to before me this 30th day of JUNE 2020 at San Carlos
City, Negros Occidental, Philippines. Affiant exhibiting to me his Senior Citizen
ID.___________