REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF DISCREPANCY

I, FERDINAND T. ALCANTARA, of legal age, Filipino Citizen, with residence

address at No. 37 Rose St. Brgy. Baesa, Caloocan, after having been duly sworn to in
accordance with law, hereby depose and state;

1. That I am a bonafide member of Philippine Health Insurance Corporation

(PHILHEALTH) with Phil HealthNumber 03-025824965-4.

2. That my date of birth appearing in my PhilHelath record is May 08, 1976

which is erroneous because my correct date of birth is May 10, 1967, copy of
my Certificate of live birth herein attached as Annex “A”

3. That FERDINAND T. ALCANTARA born on May 08, 1976 and

FERDINAND T. ALCANTARA born on May 10, 1967 belongs to me as one
and the same person;

4. That the discrepancy was unintentional and was the product of typographical
error;

5. That I am executing this affidavit in order to attest the truth of the foregoing
facts and to request proper authorities to correct my date of birth from May
08, 1976 to May 10, 1967 and for all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this 9 th day of July

2019 at Quezon City Philippines.

FERDINAND T. ALCANTARA
Affiant

SUBSCRIBED AND SWORN to before me this 9th day of July 2019 at Quezon
City Philippines, affiant exhibiting to me her Philhealth ID No. 03-025824965-4 as his
proof of identity

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of2019