REPUBLIC OF THE PHILIPPINES )

CITY OF DUMAGUETE ) S.S.

PERSONAL AFFIDAVIT OF DISCREPANCY

I, MICHAL JOSE Jr. BALDADO MERCADO, male, of legal age, Filipino, and a
resident of Purok Cebaska, Bagacay, Dumaguete City, after having been sworn to in accordance
with law, do hereby depose and state, that:

1. My full name as stated and registered in my Certificate of Live Birth issued by the Civil
Registrar of Negros Oriental (Dumaguete City) is MICHAL JOSE Jr. BALDADO
MERCADO.

2. Various Identification Cards issued by the Government also bears the same name. A copy
of my Certificate of Live Birth is herein attached as Annex “A”. A copy of my
Driver’s License bearing the same complete name is also attached herein as Annex “B”.
Finally, a copy of my Postal Identity Card is also attached herein as Annex “C”;

3. Unfortunately, in the Certificate of Appointment issued by the Civil Service

Commission to support my appointment as Clerk II of the Provincial Governor’s
Office, my name is indicated as MICHAEL BALDADO MERCADO. A copy of the
aforementioned Certificate of Appointment is herein attached as Annex “D”;

4. I have just recently discovered the abovementioned inadvertence as I was collecting and
processing the requirements needed for my application for a VISA to the United States.

5. This inadvertence was never intended to defraud anyone, or to commit any malicious act
against anyone;

6. This Affidavit is executed to support my application for a VISA to the United Stated and
for whatever legal purpose this may serve me best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of June, 2019
in Dumaguete City.

MICHAL JOSE JR. B. MERCADO

Affiant
Identification Card: DRIVER’S LICENSE
Identification Card No.: GO2-19-002923
Issued at: LTO- Dumaguete City
Valid Until: 2024/02/06
 ACKNOWLEDGMENT

SUBSCRIBED and SWORN to before me this ____ day of June, 2019, personally
appeared Affiant who is known to me and identified by me by competent evidence of identity in
accordance with the 2004 Rules on Notarial Practice, who exhibited to me the above
identification card, who executed this foregoing Personal Affidavit of Discrepancy and
acknowledged that the same is his free and voluntary act and deed. This instrument consisting of
two pages, including this page whereon this acknowledgement is written has been signed by
Affiant.

            IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal this
_____ day of June, 2019 in Dumaguete City, Philippines.

Doc. No._____
Page No.____
Book No. ____
Series 2019.