REPUBLIC OF THE PHILIPPINES)

IPIL, ZAMBOANGA SIBUGAY) S.S.

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AFFIDAVIT OF DISCREPANCY IN MIDDLE NAME

I, __________________________, of legal age, Filipino citizen,

single/married/, and with residence address at ______________________,
Philippines, having been duly sworn to in accordance with law, do hereby depose
and state:

1. That in my Certificate of Live Birth as recorded in the Office of the Civil

Registrar of _____________________, Philippines, my middle name
was erroneously written as “Crux” instead of my true and correct middle
name of “ Cruz”;

2. That my true middle name is “CRUZ”; as appearing in the same

Certificate of Live as the maiden name of my mother;

3. That in all pertinent documents which I had used, to include that of my

scholastic records (transcript of records), I used my true and correct
middle name of “CRUZ”; and

4. That I am executing this Affidavit of Discrepancy to attest to the truth of

the foregoing facts and to explain the discrepancy in my Certificates of
Live Birth, as regards my true middle name.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of

July, 2023 at Ipil, Zamboanga Sibugay.

___________________________
 Affiant

SUBSCRIBED AND SWORN to before me this 28th day of July, 2023, in

Ipil, Zamboanga Sibugay, Philippines, affiant exhibiting to me his competent
evidence of identity through Professional Driver’s License with ID number J05-16-
000004.

Doc. No.________;
Page No.________;
Book No.________;
Series of 2023.