AFFIDAVIT OF DISCREPANCY

I, , of legal
age, single/married/widow, citizen of and presently
residing at ,
after having been duly sworn to in accordance with law, do hereby depose and say:

That my name is , as stated

and registered in my birth certificate issued by the local civil registrar in country of my
birth, Republic of the Philippines;

That during my childhood and adult years, I have been accustomed to the use of
the name ;

That I assumed the name , when I

signed official documents and exercised my professional work in Canada;

That the names and

refer to one and the same person; and

That I am executing this Affidavit to clear any discrepancy which may arise
from official documents bearing either name “ ” or
“ “;

IN WITNESS WHEREOF, I have hereunto set my hand this

at , Canada.

(Affiant)

Signed in the presence of:

at the Philippine Consulate General, Toronto, Ontario, Canada