Republic of the Philippines )

Plaridel, Bulacan ) S.S.

AFFIDAVIT OF DISCREPANCY
(One and The Same Person)

I, ______________________, of legal age, married, Filipino citizen and with

residence address at _____________________, Philippines, after having been duly sworn on
oath in accordance with law hereby depose and say:

1. That I was born on __________________, With parents _____and _____ ____;

2. That in my SSS record, my name registered therein was __________, while in my

Pag-ibig record, my name indicated therein was, _______________hence, this
Affidavit of Discrepancy and Same Person;

3. That I hereby state under oath that the names ______________________and

______________refer to one and the same person and that person is
_____________________________;

4. That I am executing this Affidavit to attest to the truth of the foregoing and hereby
states that the names _______________________and
_______________________refer to one and the same person in support of my Pag-
ibig claim and for all legal intents and purposes it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto signed my name this 28th day of February
2024 in Plaridel, Bulacan.

_______________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 28th day of February 2024,

in Plaridel, Bulacan, affiant exhibiting to me his/her _________________valid until
________________as competent evidence of identity.

Doc No.
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Book No.
Series of 2024