AFFIDAVIT OF DISCREPANCY IN NAME

I, _________________, of legal age, married to _________________, and a

resident of _____________________, under oath, state:

1. That my name is ___________________ as stated and registered in my

birth certificate issued by office of the Civil Registry of Carles, Iloilo. A copy
of my birth certificate is hereto attached as ANNEX "A";

2. That the name ________________________ also appears in my marriage

certificate issued by the office of the Civil Registry of Panitan, Capiz. A copy
of my marriage certificate is hereto attached as ANNEX "B";

3. That since childhood, my friends and acquaintances call me ___________

and thus since then I have been accustomed to using the name
_______________ in my personal records, transactions and communications;

4. That the name _________________ registered in Contract No.

_______________ of _____________ was mistakenly entered. Thus,
__________ and ________refer to one and the same person, the herein
Affiant;

5. THAT 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.

I am executing this affidavit for the purpose of the authorities concerned of

veracity of the foregoing facts and for whatever legal purposes it may serve.

IN WITNESS WHEREOF I hereunto set my hand this_____________

in Roxas City, Capiz, Philippines.

________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME a Notary Public of

____________, on this , personally appeared, known to me to be the
same person who executed the foregoing instrument, and she acknowledged to that
the same is his free act and deed.

Doc No. ___

Page No. ___
Book No. ___
Series of 2023.