REPUBLIC OF THE PHILIPPINES )

Province of Cagayan )  S.S.

City/Municipality of Tuguegarao )

AFFIDAVIT OF DISCREPANCY
 
            I, LIEZEL BERNARDINO USIGAN, of legal age, single, Filipino
and a resident of Calaoagan Dackel, Gattaran, Cagayan, Philippines,
after having been duly sworn in accordance with law, hereby depose and
state:
1. I am a graduate of Medical College of Northern Philippines with a
course Bachelor of Science in Radiologic Technology, a 4-year course;
2. At present I intend to take a licensure/board examination for the said
course which will be held December 2022;
3. As for my school records from elementary to college, I have been using
my certificate of live birth with registry number 99-1792 (hereto
attached as ANNEX “A”), using first name Liezel and the place of birth
that is Aparri, Cagayan;
4. However, when I procured a copy of my certificate of live birth from
the Philippine Statistics Authority which is a requirement for the
taking of board examination, I was surprised when another certificate
of live birth was issued to me with another registry number 99-661
(hereto attached as ANNEX “B”) – different from the first
aforementioned certificate of live birth;
5. That in the certificate of live birth with registry number 99-661, my
first name appears to be LEIZLE and the place of birth is Gattaran,
Cagayan;
6. According to the Philippine Statistics Authority (PSA), the first
aforementioned certificate of live birth (i.e., registry number 99-1792)
is already locked or no longer accessible, viz., what is on file that is
accessible with the PSA is my certificate of live birth with registry
number 99-661.
7. My true and correct first name is LIEZEL since my parents call me
that name since childhood and even to this date, and also my true
and correct place of birth is Gattaran, Cagayan, and proof to that,
hereto attached is my PhilHealth identification card with registry
number 06-025423730-5 as ANNEX “C”;
8. That the first names LIEZEL and LEIZLE refers to one and the same
person, and that is me, herein affiant, though it has to be stated that
my true place of birth is Gattaran, Cagayan as reflected in my
certificate of live birth with registry number 99-661;;
9. I humbly request that by this affidavit, the Philippine Regulation
Commission will allow me to take the board examination with the
undertaking that I will make the necessary action/s for the proper
official correction whether through judicial or administrative;

I am executing this affidavit to attest to the foregoing facts and to

support my plea of taking the incoming board/licensure examination
that at present I am having my intensive inhouse review backed by my
school.
     
IN WITNESS WHEREOF, I have hereunto set my hand this 11 th of
November 2022 at Tuguegarao City, Cagayan.

LIEZEL BERNARDINO USIGAN

Affiant
PhilHealth identification registry
number 06-025423730-5

SUBSCRIBED AND SWORN TO before me this 11th of November

2022 at Tuguegarao City, Cagayan. The affiant showing me her valid
identification card written below her above signature as valid proof of
identity.

ROBIN R. ARSITIO
Public Attorney
PAO-District of Tuguegarao City
Hall of Justice, Carig
Tuguegarao City, Cagayan
(Pursuant to RA 9406)