AFFIDAVIT OF DISCREPANCY OF MIDDLE NAME

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

1. I was born

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. When I secured the Joint Affidavit and after scrutinizing the same, I discovered that the
name of my mother was recorded as as recorded in her Certificate of Live Birth. Hence,
the discrepancies;

4. I am executing this Affidavit to attest to the discrepancies in the entries of my mother’s

name in the said document;

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 ____, Philippines.

Notary Public

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