REPUBLIC OF THE PHILIPPINES )

Province of ________ ) S.S.

AFFIDAVIT OF DISCREPANCY

I, ____________________________, ________ years old, Filipino, a resident of

___________________________________, after having been subscribed to an oath,
depose and say:

1. That I was born on __________________ in ______________________ to the

spouses __________________________ and ___________________________;

2. That since childhood, I am known by the name

__________________________which I have been using in all my personal and
academic records, transactions and communications;

3. Recently, I requested an authenticated copy of my Certificate of Live Birth at the

Philippine Statistics Authority (PSA) as one of the required documents for
__________________;

4. However, I found out that the name reflected therein is

________________________. Please see attached copy of Certificate of Live Birth
from PSA;

5. That I hereby attest that ________________________ and ____________________

refer to one and the same person, the herein Affiant;

6. That this affidavit is further executed to attest to the truth of the foregoing facts and
circumstances and for all legal intents this may serve best;

IN WITNESS WHEREOF, I hereby set my hand this ____________________in

_______________________________.

________________________
Affiant
I.D No. __________________

SUBSCRIBED AND SWORN to before me this ____________________ at

__________________. Affiant exhibited to me his/her valid I.D with No. Indicated
below his/her name.

Doc. No. __________;

Page No.__________;
Book No. __________;
Series of 2020.