Republic of the Philippines )

Quezon City ) S.S.

AFFIDAVIT OF DISCREPANCY

I, MARITES T. AGUSTIN, Filipino, of legal age and with residence at

Blk. 1, Lot 22, Diamond Hoa, Riverside St., Brgy. Commonwealth, Quezon City ,
after having been sworn to in accordance with law, do hereby depose and
state that:

1) I am MARITES P. TALENS as reflected in my Birth Certificate which is

hereto attached as Annex “A”.

2) When I got married, I changed my name to “MARIA THERESA T.

AGUSTIN”.

3) However, my FIRST NAME in my Marriage Contract states that I am

“MARIA THERESA” which is hereto attached as Annex “B”.

4) I have been using the name “MARIA THERESA T. AGUSTIN” in my

Social Security System (SSS) ID and Driver’s License which is hereto
attached as Annex “C”.

5) I further certify that the names MARITES P. TALENS and MARIA

THERESA T. AGUSTIN refer to one and the same person.

6) I am executing this affidavit to attest to the truth of the foregoing

narration of facts and for whatever legal purposes and intents this
may serve.

IN TESTIMONY WHEREOF, I have hereunto affixed my signature on

23rd November 2017 in Quezon City indicated in the Jurat.

MARITES P. TALENS
Affiant

SUBSCRIBED AND SWORN to before me in Quezon City this 23rd day of

November, 2017 by ____________________, who has satisfactorily proven to
me her identity through __________ with number ______________ issued at
___________ valid until ______________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017