REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF PANIQUI )

AFFIDAVIT OF DISCREPANCY

I, CHARLIE DELA FUENTE SANTOS, of legal age, Filipino citizen, single, with
address at Barangay Cariño, Paniqui, Tarlac, after having been duly sworn to according to law
hereby depose and state:

1. That I was born on January 6, 1994 at Bubulong Malaki, San Ildefonso, Bulacan to
Spouses Paquito Santos and Jacquiline P. Dela Fuente;

2. That my birth was registered at the Office of the Local Civil Registrar of Paniqui,
Tarlac bearing registry number 94-01878;

3. That in my Certificate of Live Birth, issued by the Philippine Statistics Authority

(PSA), my gender was erroneously entered as MALE, as it should be FEMALE, as
I am physically and biologically a female;

4. That the error as regards to my gender was due to some honest mistake in filling up
the said entry, without any malicious intent or purpose and was not done in bad
faith;

5. That the names CHARLIE DELA FUENTE SANTOS, marked as MALE, as per
Certificate of Live Birth and CHARLIE DELA FUENTE SANTOS, who is
physically and biologically a FEMALE, refers to one and the same person;

6. That I am executing this affidavit in order to attest to the truth of the foregoing
circumstances, and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of February, 2018,
at Paniqui, Tarlac.

CHARLIE DELA FUENTE SANTOS

Affiant

SUBSCRIBED and SWORN to before me, in the Municipality of Paniqui, Province of

Tarlac, this 26th day of February, 2018, by Charlie Dela Fuente Santos, personally known to me
and who in person signed before me the foregoing affidavit.

Doc. No.____;
Page No.____;
Book No.____;
Series of 2018