AFFIDAVIT OF DISCREPANCY

I, ______, of legal age, widow, and with address at ____________,

under oath, state:

1. THAT I was married with my late husband, ________, on

February 19, 1970, solemnized by Municipal Judge,
____________ at the office of the Municipal Judge of La Paz,
Agusan del Sur;

2. THAT the family name of my late husband and his father

was inadvertently misspelled as “_________” as stated and
registered in our Marriage Contract issued by office of the
Civil Registry of the municipality of La Paz, Agusan del
Sur, instead of “__________” which is his true and correct
family name. A copy of my Marriage Contract is hereto
attached as ANNEX “A”;

3. THAT I am executing this Affidavit to attest to the truth of

the foregoing facts and to use the same for the SSS burial
and death claim of my late husband, _______________.

IN WITNESS WHEREOF, I hereunto affix my signature this 24 th

day of November, 2020 at Butuan City.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this 24th day of

November, 2020 at Butuan City, Affiant exhibiting to me her
COMELEC ID with VIN: 0304-0043A-K2449MBG20000 issued at La
Paz, Agusan del Sur.

 
Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of ________.