REPUBLIC OF THE PHILIPPINES )

PASIG CITY  ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, Ana Ruby Magan, of legal age, single, and with address at 029 Sitio Pagkakaisa
Zone 4 Sucat Muntinlupa City, under oath, state:

1. THAT my name is Ana Ruby Magan born on 13 April 1991 with place of
birth at Washington Makati City, Manila;

2. THAT when I secured my Passport Application Form with the Department

of Foreign Affairs (DFA) it appears that my place of birth is at PHL Calbayog,
Western Samar;

3. THAT my true and correct place of birth is at Washington Makati City,

Manila as stated and registered in my birth certificate issued by Office of the
Civil Registry. A copy of my birth certificate is hereto attached as ANNEX “A”;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing

facts for the purpose of correcting my place of birth in my DFA Passport
Application Form and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 5th of May 2021 at Tagaytay
City.

ANA RUBY MAGAN

Affiant

SUBSCRIBED AND SWORN to before me this 5th of May 2021 at Tagaytay City, Affiant
exhibiting to me her Postal ID bearing PRN N47200257180 P issued at Manila on 5th of
March 2012.

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of 2021.