REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF LAPUYAN) S.S.

AFFIDAVIT OF DISCREPANCY

I, ________________________, of legal age, single, and with address at Barangayy

_________________________________, under oath, state:

1. THAT my name is ____________________________ as stated and registered in my birth

certificate issued by office of the Civil Registry of Lapuyan. A copy of my birth certificate is
hereto attached as ANNEX “A”;

2. THAT since childhood, my friends and acquaintances call me ___________________ and thus
since then I have been accustomed to using the said name in my personal records, transactions
and communications;

3. THAT the name ________________________ and ___________________ refer to one and the

same person, the herein Affiant;

4. 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

________________ Municipality.
 

__________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ___________, 2022 at

___________________, Affiant exhibiting to me her _____________ No.
______________________________ issued at ______________ on _________________.
 

Doc No. ________;

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