Republic of the Philippines

City of____________________.

AFFIDAVIT OF DISCREPANCY

I, __________________________, Filipino Citizen, of legal,

private employee, presently living at
______________________________, under oath, hereby
deposed and state the following:

1. That I am executing this AFFIDAVIT in support to

my application for ____________________ before the
______________________________;

2. That I was born _____________________ to my

parents ______________________ and
_________________;

3. That in compliance with the above-application, I

secured a copy of my ______ and the same was
issued under-control number ______________.
However, in my Certificate of ________ clerical error
was committed because the first name of my father
was written as “____________”;

4. In support thereof, I secured an authenticate copy of

his _______________. Based on records, the real first
name of my father is __________ and not _______ as
appearing in my ________________;

5. That I am attesting to the truthfulness that

_______________________ and ________________ as
appearing in my _____________ and appearing in my
certificate of live birth respectively is one of the same
person; That the said person is my biological father;
 6. That I am executing this affidavit not for the
purpose of fraud, perjury and to perpetuate
injustice.

____________________________

SUBSCRIBED AND SWORN TO this _________day of

__________, at_________________. Affiant personally appeared
before me and presented her _________________ and freely
and voluntary signed the foregoing AFFIDAVIT
DISCREPANCY as her free won act and deed.

Docs. ____
Page no._______
Book no.
Series of 2021 NOTARY PUBLIC