Republic of the Philippines )

Province of Isabela ) S.S.

____________________ )
x------------------------------------x

AFFIDAVIT OF DISCREPANCY

I, LUZ T. BOMBARDA, of legal age, Filipino and a resident of Song song, Gamu, Isabela,
after having been duly sworn to in accordance with law, hereby depose and say that:

1. I am the same person executing this affidavit;

2. That I am using the middle name “SUMALBAG” since childhood and all my
transactions before my marriage;

3. However, upon looking in the CERTIFICATE OF LIVE BIRTH duly issued by the
Philippine Statistics Authority (PSA), my middle name is erroneously registered as
“SUMALBAR” instead of “SUMALBAG”;

4. I hereby certify and swear that the person with the middle name “SUMALBAR”
which appeared in the CERTIFICATE OF LIVE BIRTH and the one with the name
“SUMALBAG”, refers to one and the same person;

5. That the discrepancy as regards my middle name was without malice or

intended to defraud anybody the discrepancy being due to honest mistake;

6. I am executing this affidavit to attest the truth of the foregoing and for whatever
lawful purposes it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _____________
2020 in ________________________, Isabela.

LUZ T. BOMBARDA
Affiant
TIN: 949-602-051

SUBSCRIBED AND SWORN to before me this ___ day of _____________ 2020 in

________________________, Isabela, with affiant exhibiting to me their proof of identity as
stated above.

Doc No. ____;

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