Republic of the Philippines)

Province of__________________) S.S.

City/Municipality of____________)
x - - - - - - - - - - - x
AFFIDAVIT OF DISCREPANCY
I,_____________,of legal age, Filipino,(single / married /
widow),and a resident of____________, Philippines having been
duly sworn in accordance with law, hereby depose and state:
That I was born to the spouses____________and ___________on
___________in _____________, Philippines as evidenced by the
Certificate of Live Birth issued by the City Civil Registrar of
the City of ____________;
That however, in the said Certificate of Live Birth, the date of
marriage of my parents was erroneously written as "May 8,1960"
instead of the true and correct date May 28, 1960" as evidenced
by the Certificate of Marriage of my parents issued by the City
Civil Registrar of the City of _____________, hereto attached as
Annex "A";
That said discrepancy in my Certificate of Live Birth was an
error done inadvertently;
That I execute this Affidavit of Discrepancy to attest to the
truth of the foregoing facts.
IN WITNESS WHEREOF, I have hereunto set my hand
this_____________at____________, Philippines.
Affiant