REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF _______________ ) ss.

AFFIDAVIT OF DISCREPANCY

I, __________________________, of legal age, single, Filipino citizen and a

resident of _______________________________, Philippines under oath and states that:

1. I have consistently used “____________________” as my name since

_______, as evidenced by my _______________ issued by __________. A copy
of which is herein attached and marked as “ANNEX A”;

2. However, my name as appearing in my __________ ID with

registration no. ______________ issued by ____________________ was
erroneously recorded as “_________________________”, instead of
“_____________________” being my true and correct name as I have
consistently used in all my public and private dealings;

3. Such discrepancy was made by my mere inadvertence in

preparation of my valid identification cards and not in any way
intended to defraud anyone or conceal my true identity;

4. I am hereby executing this affidavit to attest to the truth of all the

foregoing and to request the __________________________ for correction
of my first name in their records from “_____________________________” to
“_________________________________”;

5. That the person referred to as “_____________________________”, and

“_____________________________”, refers to one and the same person; and

6. Finally, I am executing this affidavit for all legal intents and

purposes this may be worth as well as to humbly request the
authorities concerned to correct the above-mentioned clerical error
in order to set my records straight.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto signed my name this

____________________, at ____________________, Philippines.

_________________________________
Affiant
ID No. __________________

SUBSCRIBED AND SWORN to before me this ____________________ at

________________________, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.