Republic of the Philippines ]

City of ______________…..…. ] S.S.

AFFIDAVIT OF DISCREPANCY

(Date of Birth)

I, _____________________________________ , of legal age, Filipino citizen, single ,residing at

_____________________________________________________________________________________
_________, UNDER OATH, do hereby depose and state THAT:

1. I am a holder of a ___________ account with _______ no. _____________ by the

________________________;
2. My date of birth recorded and appearing in my aforesaid MISMO account is ______________
which is erroneous because my correct date of birth is ________________ as shown in my
driver's license, copy of which is here to attached as ANNEX A;
3. I have this affidavit executed to attest to the truth of the foregoing and for purposes of
reporting the same to the _____________________ so that my date of birth erroneously
recorded as _________________ can be corrected to _______________ and to request for a
replacement or correction of _____________ account and __________ number bearing my
correct date of birth.

IN WITNESS WHEREOF, I have here unto affixed my signature on this ___th day of
_______________ in _________________________________________________.

_______________________________________________

Affiant

SUBSCRIBED AND SWORN to before me on this ___th day of _________________in

____________________________Philippines. Affiant exhibited as evidence of identity driver's license.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;

Book No.______;

Series of 20____..