AFFIDAVIT OF DISCREPANCY IN NAME

I, _____________________, of legal age, married, and with address at

______________________________________________________, under oath,
state:
1. THAT my name is ____________________ as stated and registered in my
birth certificate issued by office of the Civil Registry of
______________________. A copy of my birth certificate is hereto attached as
ANNEX “A”;

2. THAT the name ___________________also appears in my passport which

was issued based on the data appearing in my birth certificate. A copy of the
page of my passport where my name and picture appears is hereto attached as
ANNEX “B”;

3. THAT since childhood, my friends and acquaintances call me ________and

thus since then I have been accustomed to using the
name ____________________in my personal records, transactions and
communications;

4. THAT the name ____________________ and _____________________ refer

to one and the same person, the herein Affiant;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts
and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this _________________

at Makati City.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Makati City,

Affiant exhibiting to me his Passport bearing No.
______________________________ issued at ______________ on
_________________. 

Doc No. ________;

Page No. _______ ;

Book No. _______;

Series of ________.

AFFIDAVIT OF DISCREPANCY

I,_____________,of legal age, Filipino,(single / married / widow), and a

resident of_____________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

That in my Certificate of Live Birth as recorded in the Office of the Civil

Registrar of__________City, Philippines, my middle name was erroneously
written as "Crux" instead of my true and correct middle name of "Cruz"

That my true middle name is "CRUZ"; as appearing in the same Certificate of

Live as the maiden name of my mother.
That in all pertinent documents which I had used, to include that of my
scholastic records (transcript of records), I used my true and correct middle
name of "CRUZ"

That I am executing this Affidavit of Discrepancy to attest to the truth of the

foregoing facts and to explain the discrepancy in my Certificates of Live
Birth, as regards my true middle name.

IN WITNESS WHEREOF,I have hereunto set my hand this___________,

at___________, Philippines.
Affian