Republic of the Philippines )

City of (Place) ) S.S.

AFFIDAVIT OF DISCREPANCY
(TO ESTABLISH SINGLE IDENTITY OF NAMES)

I, (NAME OF AFFIANT), Filipino, of legal age, single/married, with postal

address at (Place of Residence), after having been sworn to in accordance with law,
hereby depose and state:

1. That in my Certificate of Birth, my middle name was erroneously written as

"(ERRONEOUS NAME)" instead of my true and correct middle name of
"(CORRECT NAME)"

2. That my true middle name is "(CORRECT NAME)"; as appearing in my

(Government-Issued ID-1) and(Government-Issued ID-2), a copy of which are
hereto attached as Annex A;

3. That in all pertinent documents which I had used, to include that of my

Election Records and GSIS Records, I used my true and correct middle name
of "(CORRECT NAME)"

4. That I am executing this Affidavit of Discrepancy to attest to the truth of the

foregoing facts and to explain the discrepancy in my Certificate of Live Birth,
as regards my true middle name.

5. That I assumed the name (NAME OF AFFIANT), when I signed official

documents and exercised my professional work in government;

6. That the names (ERRONEOUS NAME), as appearing in my Philippine

Passport of (Years of Passport Validity), and (CORRECT NAME), as
appearing in my government-issued IDs, refer to one and the same person,
which is the undersigned/affiant herein;

7. That I am executing this Affidavit to clear any discrepancy which may arise
from official documents bearing either name (ERRONEOUS NAME)" or
(CORRECT NAME).

IN WITNESS WHEREOF, I have hereunto affixed my signature this (Date) in

(Place).
 NAME OF AFFIANT
Affiant

SUBSCRIBED AND SWORN to before me this (Date) in (Place), with affiant

exhibiting to me his (ID Details).

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of _____.