REPUBLIC OF THE PHILIPPINES)

______________ )SS.

AFFIDAVIT OF DISCREPANCY

I, ___________, of legal age, Filipino, and a resident of ____________, under oath,

state:

1. That I my name was indicated as “___________” in my Certificate of Live Birth;

2. Despite such fact however, I have always used the name “_______________,” the
name I grew up with;

3. That I have no idea as to how my name, and my birth year, as recorded in my

Certificate of Live Birth,is different from my name, _______________, in all my
government-issued IDs;

4. That I truthfully swear that ____________, as indicated in my Certificate of Live

Birth, and “_____________” as indicated in all my government-issued IDs, is just
one and the same;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to
use this Affidavit for whatever legal purpose it may serve

IN WITNESS WHEREOF, I have hereunto signed this document on the

__________

______________
Affiant