Affidavit of Discrepancy Date of Birth)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

AFFIDAVIT OF DISCREPANCY

I, _____________, of legal age, (single / married / widow), Filipino and a

resident of _____________, Philippines, having been duly sworn in accordance
with law, hereby depose and state:

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

Registrar of _____________ City, Philippines and Secondary Student
Permanent Record at _____________ High School, it is stated that I was
born on 21 May 1970 at _____________, Philippines;

That my relatives, acting on the honest belief that I was born on 21 May
1971, had used 21 May 1971 as my birth date in all pertinent school
records when they processed my enrollment at _____________ in
_____________;

That when I filled up my voter's registration record required by the

Commission on Election last _____________, I had inadvertently and
erroneously written the date of my birth as 21 May 1971 instead of 21
May 1970;

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, Secondary Student Permanent Record, Transcript of
Records and Voter Registration Form as regards to my date of birth;
 Further, I am declaring that from this date hereon I would be using my true
and correct date of birth of 21 May 1970 in all my papers, records and
other documents.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________, at _____________, Philippines.

AFFIANT

(JURAT)