REPUBLIC OF THE PHILIPPINES)

______________________ ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

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 passport which was issued
based on the data appearing in my birth certificate. A copy of the page of my passport
where my name and picture appears 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 __th of _____________ at

Mandaluyong City.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Mandaluyong City,

Affiant exhibiting to me his Identification bearing No. ______________________________
issued at ______________ on _________________.

Doc No. ________; NOTARY PUBLIC

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