Republic of the Philippines )

City of Tacloban ) S.S.

AFFIDAVIT OF DISCREPANCY OF NAME

I, GENIE PAZ LOBRIGO ARCEÑO, of legal age, widow, Filipino, and a

resident of Dagami, Leyte, after having been duly sworn to in accordance
with law, do hereby depose and say that:

1. My name is Genie Paz Lobrigo Arceño;

2. My birth certificate issued by the Office of the Civil Registrar, indicates

that my name is GENIE PAZ LOBRIGO ARCEÑO. A copy of which is
hereto attached as “Annex A”

3. On the other hand, on the Philippine Crop Insurance Corporation (PCIC)

application and on the check issued by them, my name is indicated as
JENIE PAZ LOBRIGO ARCEÑO

4. Both names pertain to one and the same person;

5. I have been using the name GENIE PAZ LOBRIGO ARCEÑO in all my
Identification Cards, documents and communications;

6. I am executing this Affidavit to attest to the truth of the foregoing

statements and to use the same for whatever legal purpose it may
serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 2 nd day of March,

2018 at Tacloban City.

______________________________
GENIE PAZ LOBRIGO ARCEÑO
Affiant
Philhealth ID No. 13-025084021-8

SUBSCRIBED AND SWORN to before me this 2 nd day of March, 2018,

affiant exhibited to me her Competent Evidence of Identity as stated above.

Doc. No. _____;

Page No. _____; Notary Public
Book No. _____;
Series of 2018