AFFIDAVIT OF DISCREPANCY OF MIDDLE NAME

I, ______________, of legal age, Filipino citizen, single, and a resident of Brgy., Philippines, after having been duly sworn
to in accordance with law, do hereby depose and states THAT:

1. I was born on ___-to_____. and _______at______.

2. Lately, I went to the Social Security System (SSS) Office, Iloilo City to process my
middle name which was not included and was required to submit a Joint Affidavit of two
Disinterested Persons Re: One and the Same Person.

3. Moreover, I am executing this affidavit to attest to the fact that the name ________,
appearing as the mother of __________in the above-said Certificate of Live Birth, and
____________, as recorded in her Certificate of Live Birth.

SUBSCRIBED AND SWORN TO before me this ____ day of ________ 20___ at ________

Notary Public

Doc. No.___;
Page No. ___;
Book No. ___;
Series of 2017.