REPUBLIC OF THE PHILIPPINES )

PROVINCE/CITY OF _____________ ) S.S

AFFIDAVIT OF DISCREPANCY IN NAME

(ONE AND THE SAME PERSON)

I, ______________________________, of legal age, married, and with address at

______________________________ under oath, state:
1. THAT my name is ______________________________ as stated and registered in my birth
certificate issued by office of the Civil Registry of ______________________________. A copy
of my birth certificate is hereto attached as ANNEX “A”;
2. THAT the name ______________________________ also appears in my voter’s certification
which was issued based on the data appearing in my birth certificate. A copy of the
page of my voter’s certification where my name and picture appear is hereto
attached as ANNEX “B”;
3. THAT since childhood, my friends and acquaintances call me
______________________________ and thus since then I have been accustomed to using the
name ______________________________ in my personal records, transactions and
communications;
4. THAT the name ______________________________ and ______________________________ refer to
one and the same person, the herein Affiant;
5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to
use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ________________ at

__________________________________________.

___________________________________________
Affiant
(FULL NAME AND SIGNATURE)

SUBSCRIBED AND SWORN to before me this _______________ at

______________________________________________________, Affiant exhibiting to me his
___________________ bearing No. ______________________________ issued at
_____________________________________ on _______________________________.

NOTARY PUBLIC

Doc No. ________;

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

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