Republic of the Philippines )

________________________ ) SC

AFFIDAVIT OF DISCREPANCY

I, JUANA LUBAT ACALA, of legal age, Filipino citizen and a resident of Maglipay, Sulat, Eastern
Samar, Leyte, Philippines, after having been duly sworn in accordance with law, hereby deposes and state
that:

1. That my true and correct name is “JUANA” and that I have been using the said name in all
my legal transactions and pertinent documents;

2. However, in the Certificate of Live Birth of my son, Roderic Acala Hilario, there was a
discrepancy on the entry of my name appearing as “JUANITA” instead of my true and
correct name;

3. As such, to remove confusion as to the aforementioned names, I hereby declare and confirm
that the person bearing the names “JUANA” and “JUANITA” truly refers to one and of the
same person;

4. That I am executing this Affidavit to attest to the truthfulness of the foregoing facts and for
the purpose of completing the requirements of marriage license and other pre-requisite for
marriage of my son Roderic Acala Hilario and for whatever legal purposes and intents the
same may serve best.

IN WITNESS WHEREOF, we have hereunto affixed our signature this ____ day of __________ 2022 in
the ___________________, Philippines.

JUANA LUBAT ACALA

Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 2022 in

the_________________, Philippines. Affiant exhibited to me her Competent Evidence of Identity
consisting of OSCA ID bearing number 1449 issued by OSCA Sulat, Eastern Samar.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2022.