REPUBLIC OF THE PHILIPPINES)

Province of _________________________) S.S.

City/Municipality of ______________)
x - - - - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF DISCREPANCY OF DATE OF BIRTH

I, , of legal age, , Filipino and

a resident of
, Philippines, having been duly sworn in accordance with law, hereby depose and
state:

1. That in my Certificate of Live Birth as recorded in the Office of the Civil Registrar
of _____________ City, Philippines and Secondary Student Permanent Record at
_____________ High School, it is stated that I was born on
at ____________________________________, Philippines;

2. That my relatives, acting on the honest belief that I was born on

, had used as my birth date in all pertinent school records
when they processed my enrollment at
in ;

3. That when I filled up my voter's registration record required by the Commission

on Election last , I had inadvertently and erroneously
written the date of my birth as instead of ;

4. That I am executing this Affidavit of Discrepancy to attest to the truth of the

foregoing facts and to explain the discrepancy in my Certificates of Live Birth,
Secondary Student Permanent Record, Transcript of Records and Voter
Registration Form as regards to my date of birth;

5. Further, I am declaring that from this date hereon I would be using my true and
correct date of birth of in all my papers, records and
other documents.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at

_____________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me, this , by the

Affiant whom I have identified through competent evidence of identity and who exhibited
his issued at on ____
_________.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.