REPUBLIC OF THE PHILIPPINES )

) S.S

AFFIDAVIT OF DISCREPANCY OF NAME

I, ____________________, of legal age, married, and with residential address at

____________________, under oath, hereby depose and state that:

1. My name is ____________________ as stated and registered in my birth certificate issued

by Office of the Civil Registry of Talisay, Batangas, a copy of which is hereto attached as
Annex “A”;

2. I am also known as ____________________ after I got married to ______________. A copy

of our Marriage Contract is hereto attached as Annex “B”;

3. The name ____________________ also appears in my government employee ID,

____________________ and ____________________, as well as in my personal records,
transactions and communication, copies of which appear herein as Annex “C”;

4. The name ____________________ as reflected in my GSIS personal records

5. The name ____________________, ____________________ and ____________________

refer to one and the same person, the herein Affiant;

6. I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ____ day of ______ 2019 at
______________________.

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ________ 2022 at

_____________________, Affiant _____________________ exhibited to me her ________________
bearing ID No. __________________.

Doc No. _____;

Page No. _____; NOTARY PUBLIC
Book No. _____;
Series of 2022.