REPUBLIC OF THE PHILIPPINES)

Taguig City, Philippines ) S.c.

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 CENOMAR issued by

Philippine Statistics Authority is { } (married name: { }).

3. In my birth certificate issued by Philippine Statistics Authority, 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.

8. 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.
9. 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 { }