Republic of the Philippines )

Province of__________________ ) S. S.
City/Municipality of____________)

AFFIDAVIT OF DISCREPANCY

I, _____________, of legal age, Filipino,(single / married / widow),and a

resident of ____________, Philippines having been duly sworn in accordance with law,
hereby depose and state:

1. That I was born to the spouses ____________ and ___________ on

___________ in _____________, Philippines as evidenced by the Certificate
of Live Birth issued by the City Civil Registrar of the City of ____________;

2. That however, in the said Certificate of Live Birth, the date of marriage of my
parents was erroneously written as "May 8, 1960" instead of the true and
correct date May 28, 1960" as evidenced by the Certificate of Marriage of my
parents issued by the City Civil Registrar of the City of _____________,
hereto attached as Annex "A";

3. That said discrepancy in my Certificate of Live Birth was an error done

inadvertently;

4. That I execute this Affidavit of Discrepancy to attest to the truth of the

foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

____________, Philippines.

Affiant

(JURAT)