Republic of the Philippines)

City of Taguig )SS

AFFIDAVIT OF DISCREPANCY

I, { }, of legal age, single, and with address at { }, Taguig City, Philippines,

subscribing under oath, state that:

1. I was born on { } at Taguig, Metro Manila.

2. My mother’s true and lawful name as indicated in my Birth Certificate issued
by Philippine Statistics Authority is { } (married name): { }.
3. In my Baptismal Certificate issued by { } , my mother’s name was entered as {
} instead of { }.
4. I would like to manifest that my mother’s true and lawful name is { }
(married name: { }).
5. { } and { }, refers to one and the same person, my mother.
6. For all intents and purposes, my mother’s true and lawful name is { }
(married name: { }).
7. I am executing this Affidavit of Discrepancy to attest to the truth of the
foregoing facts and to use the same for whatever legal purpose it may serve.
8. Affiant further sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature this { } at Taguig City.

{}
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in Taguig
City, personally appeared { } at Taguig City, { } with { } ID no: { } issued by { }, the
same bearing affiant's photograph and signature, and who attested that she is the
same person who personally signed before me the foregoing document and
acknowledged that she executed the same.

Doc No: { }
Page No: { }
Book No: { }
Series of { }