Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF DISCREPANCY
I, ______________, ____ years old, Filipino citizen,
single/married/widower/widow, and a resident of Barangay
____________________, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:

1. I am a farmer by profession, thus, I was listed in the

____________________ as one of its ______________;

2. I am using ____________ as my first name since birth and until I came

to age of reason, hence, all my documents and identifications cards
bear such name;

3. Lately, I applied for a loan at the __________________ as one of the

assistance rendered to farmers; it was then that I discovered that in the
__________________ that my first name appearing therein is
_______________ instead of ______________. Hence, the
discrepancy in my first name;

4. I am executing this Affidavit to attest to the fact that

_________________ as appearing in the ___________________,
_________________ as appearing in my ______________________;
and _________________ as appearing in my ___________________,
refer to one and the same person, and that is me, _____________;

5. Finally, I am executing this affidavit to attest to the truth of the foregoing

statements and for whatever legal intents and purposes this may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____

day of ______________, 2019, at _______________, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant presented before me his/her ___________________.