REPUBLIC OF THE PHILIPPINES}

PROVINCE OF }
MUNICIPALITY OF ___________ } S.S.

AFFIDAVIT OF DISCREPANCY
I, ZZZ DEF, of legal age, Filipino, (single/married/widow) and a resident of
_______________________________, after having been duly sworn to in accordance with
law, depose and state THAT:

1. I was born on _____ day of the ____________ 2000 to spouses YYY ABC and XXX
DEF;

2. I have been using the name ZZZ DEF in all my documents and transactions;

3. However, when I obtained a copy of my birth certificate, I discovered that my

surname appearing thereon was erroneously written as "DIF";

4. The names “ZZZ DEF” and “ZZZ A. DIF” refer to one and the same person;

5. I execute this Affidavit of Discrepancy of Surname to attest to the truth of the

foregoing facts and to explain the discrepancy in my birth certificate with regards my
surname.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ____________
2021 in _____________________, Philippines.

_______________________________
XXXXXXXXXXXXXXXXXX
Affiant
ID No.
Issued on:
Place of Issue:

SUBSCRIBED AND SWORN to before me at_______________________,

Philippines this _____ day of ___________, 2021, affiant exhibiting before me her
Competent Evidence of Identity written below her name and signature, that she is the
same person who personally signed before me the foregoing Affidavit and
acknowledged that she executed the same.