Republic of the Philippines)
Province of Masbate )
City of Masbate )
x---------------------------------x
AFFIDAVIT OF DISCREPANCY
I, __________________________________, of legal age, and a resident of
___________________________________________________, after having been duly sworn to in
accordance with law, hereby depose and say:
1. That since I was young, I have been using the name __________________________;
2. That I have been known by my family and friends as
__________________________________________;
3. That when I requested for a copy of my Birth Certificate from the National
Statistics Office, I was surprised that my name as reflected on the official document
is ____________________________________________ (A copy of the Birth Certificate is hereto
appended as ANNEX A and forms an integral part hereof);
5. That I attest that _________________________________ and
_____________________________________ is one and the same person;
6. That from now on, I will be using my true and correct
name, ___________________________________________.
7. That I am executing this affidavit in order to attest to the truth of the facts
aforementioned, and for any legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ________th day of
__________________, ____________ at Masbate City, Philippines.
________________________________________
Affiant
SUBSCRIBED AND SWORN to before me this ________th day of __________________,
____________ at Masbate City, Philippines.
Doc No. ____;
Page No. ___;
Book No. ___;
Series of 2017.