Republic of the Philippines)

City of _____________ )S.S.

AFFIDAVIT OF DISCREPANCY

I, ________________, of legal age, Filipino and with postal address at

__________________________________, that after having been duly sworn to
in accordance with law, depose and state:

1. That I am a _______________;

2. That I cause the preparation of the Certificate of Marriage of Spouses

________________________;

3. That in the course of the preparation of the same I inadvertently typed

the name of _____________ as ________________ in the lower
portion of the document where he affixed his signature;

4. That the aforementioned discrepancy was noticed by the

________________ when they secured a copy of the same at the
Office of the Civil Registrar______________;

5. That I am executing this Affidavit in order to attest to the truth of the

foregoing;

WHEREFORE, I have hereunto set my hand this _________ th day of

___________ at the City of _____________.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this __________ day of

________ at ___________, upon affiant exhibiting to me ___________ bearing
_______________ issued by the ___________________.

Doc. No. _______:

Page No. _______:
Book No. _______:
Series of 20_____