REPUBLIC OF THE PHILIPPINES )

_______________________________)
_______________________________) S.S.

AFFIDAVIT OF DISCREPANCY IN NAME

I, ______________________, of legal age, Filipino, married and a resident

of _______________________, after having been duly sworn to in accordance
with law hereby depose and state:

1. That my name is _________________ as stated and registered in my

Certificate of Live Birth issued by the Office of the Local Civil Registrar,
_____________. A copy of the certification issued by the Office of the Civil
Registrar________________ is attached herewith and marked as Annex
“A”;

2. That in the Certificate of Live Birth of my son, ______________, my name

was erroneously stated as ___________________;

3. That I have been using the name ________________ in all my personal

records, official transactions and communications;

4. That the name ________________ and ___________________ refer to one

and the same person, herein affiant;

5. That I am executing this Affidavit to attest to the truth of the foregoing facts
and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ____ day of

____________ at _________________.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of

____________________ at ______________, Affiant exhibiting to me his
____________________.

_______________________