Republic of the Philippines)

Calapan City ) S.S.

AFIDAVIT OF DISCREPANCY
I, CHRISTIE, of legal age, Filipino, widower and with residence and
postal address at, Oriental Mindoro, after having been sworn to in accordance
with law, hereby depose and state:

1. That, I am the wife of late B who died last 27 May 2022 at Calapan
City, Oriental Mindoro;

2. That I have applied for the SSS Death Claim Benefits of my late
husband however upon claiming for the same, I was informed
that there is a discrepancy on the SSS Form which he filled out
during his application. He accidentally indicated that his father is
“C” instead of “D”.

3. That, “C” is my father.

4. That, I hereby attest that my husband father’s name is “D” as

evidenced by his Certificate of Live Birth.

A copy of my late husband Live Birth Certificate is attached herewith for

reference.

5. That this affidavit is being executed to attest to the truth of the

foregoing statements and for whatever legal purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

______________ at Calapan City, Philippines.

CHRISTIE
Affiant

SUBSCRIBED AND SWORN TO before me this ____________________ at

Calapan City, Philippines. The affiant exhibiting to me his government issued
ID with number ____________________ and known to me to be the same person
who executed the foregoing instrument freely and voluntarily.

NOTARY PUBLIC

Doc. No. _____

Page No. _____
Book No. 03
Series of 2022