REPUBLIC OF THE PHILIPPINES)

CITY OF QUEZON, M. MLA. ) SS.

AFFIDAVIT OF NAME DISCREPANCY

I, CORAZON B. MENDOZA (SOTERA BATHAN MENDOZA), of legal age, married, Filipino,

residing at B8 L38 Natividad Subd., Ph4 Deparo, Caloocan City, after having sworn to law
depose and say:

That in my school records my name is CORAZON B. MENDOZA, and to my relatives,

friends and all personal transactions, whether private or public, I used and known as CORAZON
MENDOZA-DELA CRUZ, being married to CARLOS DELA CRUZ;

That in my Birth Certificate, it appeared that my name is SOTERA BATHAN MENDOZA;

That CORAZON B. MENDOZA, CORAZON MENDOZA DELA CRUZ and SOTERA BATHAN
MENDOZA is one and the same person, who is very truly yours;

That I executed this affidavit to establish the veracity of the foregoing fact.

IN WITNESS WHEREOF, I hereunto set my hand this 6th day of March, 2017 at Quezon
City.

CORAZON B. MENDOZA/SOTERA BATHAN MENDOZA

Affiant

SUBSCRIBED AND SWORN to before me this 6th day of March, 2017 at Quezon City,
affiant exhibited her Police Clearance ID Card with expiry date July 6, 2017.

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