Republic of the Philippines)
Province of___________________) S.S.
City/Municipality of___________)
x-----------------------x
AFFIDAVIT OF DISCREPANCY
I, ANNA JAIRA L. BORJA, of legal age, Filipino, single, and a resident of
509 5th street San Martin subdivision Angono, Rizal, Philippines, having been
duly sworn in accordance with law, hereby depose and state:
1. That in my Certificate of Live Birth that was submitted to my school, ICCT
Colleges Foundation , Inc., my surname was “SANTOS”;
2. That my true surname is “BORJA”, as evidenced by the NSO authenticated
copy that was issued to me by the said agency. (Hereby attached as Annex
“A”);
3. That in all pertinent documents which I am about to use, including that
of my scholastic records (transcript of records), I intend to use my true and
correct surname of "BORJA";
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 Certificates of Live
Birth, as regards my true surname.
IN WITNESS WHEREOF,I have hereunto set my hand this______________,
at___________, Philippines.
ANNA JAIRA L. BORJA
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ___________ at
_________________ affiant exhibiting to me her_________________ with No.
_________________ issued at _________________.
Notary Public
Doc. No. ;
Page No. ;
Book No. ;
Series of 20__.
Republic of the Philippines)
Province of___________________) S.S.
City/Municipality of___________)
x-----------------------X
AFFIDAVIT OF DISCREPANCY
(ONE AND THE SAME PERSON)
I, ANNA JAIRA L. BORJA, of legal age, Filipino, single, and a resident of
509 5th street San Martin subdivision Angono, Rizal, Philippines, having been
duly sworn in accordance with law, hereby depose and state THAT:
1. In my Certificate of Live Birth that was submitted to my school, ICCT
Colleges Foundation , Inc., my surname was indicated as “SANTOS”;
2. My true surname is “BORJA”, as evidenced by the NSO authenticated
copy that was issued to me by the said agency. (Hereby attached to as
Annex “A”);
3. In all pertinent documents which I am about to use, including that of my
scholastic records (transcript of records, school diploma, etc.), I intend to
use my true and correct surname of "BORJA";
4. Both names/documents pertain to one and the same person.
5. I am executing this Affidavit to explain the discrepancy in my Certificates
of Live Birth, as regards my true surname.
6. I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal purposes it may serve.
ANNA JAIRA L. BORJA
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ___________ at
_________________ affiant exhibiting to me her_________________ with No.
_________________ issued at _________________.
Notary Public
Doc. No. ;
Page No. ;
Book No. ;
Series of 20__.
LETTER OF DISCREPANCY
OFFICE OF THE SCHOOL REGISTRAR
ICCT Colleges Foundation, Inc.
Dear Ma’am/Sir:
I am writing this letter in order to respectfully request for the
correction of the entry in my scholastic record. In my submitted Certificate
of Live Birth, it appeared that my surname was “SANTOS”. However, upon
verification with my NSO authenticated Certificate of Live Birth, it
appeared that my surname is “BORJA”.
In line with this, I am asking your kind office to effect the necessary
correction in order for my scholastic records to reflect my true surname.
It is with great pride for me to graduate from this institution; and I am
really hoping for my records to be corrected in order for me to continue on
with my future plans with my corrected records in tow.
I am also submitting along with this letter a notarized copy of my
affidavit to prove that my certificates of live birth refer to one and the same
person.
Hoping for you kind consideration regarding this matter.
Respectfully Yours,
ANNA JAIRA L. BORJA
