Republic of the Philippines )

Province of La Union ) S.S.

City of San Fernando )
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AFFIDAVIT OF DISCREPANCY/EXPLANATION
I, JOSEFINA BIASON NAVARRO, of legal age, Filipino citizen, and a resident of Brgy.
Bantayan, Mangaldan, Pangasinan, Philippines, having been duly sworn in accordance
with law, hereby depose and state:

1. That I am a bonafide holder of a Philippine Passport with Passport No.

EC8474743 bearing my Date of Birth at “25 Dec 54”;

2. That as reflected on my Certificate of Birth issued by National Statistics Office

(now Philippines Statistics Authority) of the government of the Republic of the
Philippines and supported by a Certification issued by the Office of the
Municipal Civil Registrar of Mangaldan, Pangasinan, my correct and exact
Date of Birth is “December 25, 1949”;

3. That my true and correct Date of Birth is “December 25, 1949” as correctly
reflected in my Certificate of Birth and Certification issued by the Office of the
Municipal Civil Registrar;

4. That the entry made in my Philippine Passport was inadvertently, erroneously,

and mistakenly encoded without any fault, malice, intent to deceit or ill motive
on my part;

5. That I am executing this Affidavit of Discrepancy/Explanation to attest to the

truth of the foregoing facts and for all legal intents and purposes that this
affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____day of ________2019 at

San Fernando City, La Union, Philippines.

JOSEFINA BIASON NAVARRO

Affiant

SUBSCRIBED AND SWORN to before me this_____of___________ in City of San

Fernando, La Union. Affiant exhibiting to me his Senior Citizen ID No. 578-17 issued
at Mangaldan, Pangasinan on April 10, 2017.

NOTARY PUBLIC

Doc No.______
Page No._____
Book No.______
Series of 2019.