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Republika ng Pilipinas)

__________________) S.S.
x-------------x

AFFIDAVIT OF DISCREPANCY
I, FERNANDO ZABAT MADRID, of legal age, Filipino, married,
and a resident of Barangay Pingit, Baler, Aurora, under oath state that:

1. That I am a holder of a Voter’s ID with no. 7701-0019A-


K2066FZM10000 issued by Commission on Election; a copy of
which is hereto attached as Annex “A”;

2. My date of birth recorded and appearing in my aforesaid Voter’s


ID is November 20, 1966 which is erroneous because my correct
date of birth is NOVEMBER 20, 1965 as shown in my Certificate
of Live Birth issued by the Local Civil Registrar of Baler, Aurora
and as shown in my Marriage Certificate; copies of which are
hereto attached as Annex “B” and Annex “C”;

3. I have this affidavit executed to attest to the truth of the foregoing


and for purposes of my hospitalization so that may date of birth
erroneously recorded as November 20 1966 can be corrected to
November 20, 1965 and for any legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____


of November 2023 at _______________.

FERNANDO Z. MADRID
Affiant

SUBSCRIBE AND SWORNTO before me on this _____ day of


November 2023 at ____________________.

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