Republic of the Philippines }

__________________ } S.S.

AFFIDAVIT OF DISCREPANCY

I, ____________________, of legal age, with residence and postal address

at __________________________________, after being duly sworn in accordance with
law, depose and state that:

1. I was born in _____________ on _____________. As proof thereof, I have

attached hereto and marked as Annex “A” a copy of the Certificate of Live Birth
issued by the Civil Registrar of ___________ City.

2. My parents’ names, as stated in the aforesaid Certificate, are

____________________ (father) and _____________ (mother). It was my
parents’ intention to give me the name ____________________with
“____________________” as my first name, “__________” as my middle name,
and “____________________” as my last name.

2.1. As typewritten in the _____________(document)_______________,

however, it will appear that my first name is only “____________”. This
is a clear typographical error.

3. At any rate, believing in good faith that my correct first name is

____________________ , I have used said first name in all my private and public
documents such as, for example, my Social Security System ID and Professional
Driver’s License, etc. Thus, for instance, the name appearing in my driver’s
license is “____________________”

4. The person named in the aforesaid _________(document)__________________ as

__________________________. and the person named in the aforesaid
Professional Driver’s License as __________________________ are one and the
same and pertain only to the undersigned.

5. I am executing this affidavit to attest to the truth of the foregoing statement and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

_____________ , 20___ at _______________.
 _______________________
Affiant

Before me, appears the person __________________________ presenting the

above AFFIDAVIT who is personally known to me or identified by me through
__________________________ issued by ______________________ a competent
evidence of identity as defined by the 2004 Notarial Rules as the person who signs the
document and in my presence takes an oath or affirmation before me as to such
document.

Witness my hand and seal this __ day of ________________, 20__

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.