AFFIDAVIT OF DISCREPANCY OF MIDDLE NAME

I, ______________, of legal age, Filipino citizen, single, and a resident of Brgy., Philippines, after having been duly sworn
to in accordance with law, do hereby depose and states THAT:

1. I was born on ___-to_____. and _______at______.

2. Lately, I went to the Social Security System (SSS) Office, Iloilo City to process my
middle name which was not included and was required to submit a Joint Affidavit of two
Disinterested Persons Re: One and the Same Person.

3. When I secured the Joint Affidavit and after scrutinizing the same, I discovered that the
name of my mother was recorded as _____________ instead ___________ as recorded in
her Certificate of Live Birth. Hence, the discrepancies;

SUBSCRIBED AND SWORN TO before me this ____ day of ________ 20___ at ________

Notary Public

Doc. No.___;
Page No. ___;
Book No. ___;
Series of 2017.