REPUBLIC OF THE PHILIPPINES )

CITY OF ____________ ) S.S.

PROVINCE OF ________ )

AFFIDAVIT OF DISCREPANCY

I, _________, Filipino, of legal age, and a resident ___________, hereby under oath state
that:

1. There was an error in the spelling of the name of my mother which appears in the
Certificate of No Marriage issued by the Philippine Statistics Authority;

2. In my Certificate of Live Birth, her name is spelled as _____. Attached is a copy of the
said Certificate of Live Birth as Annex “A”, and is made part hereof;

3. Unfortunately, the CENOMAR issued to my name has erroneously spelled her name as
__________;

4. The discrepancy in the spelling of her name might have been caused by the inadvertence
of the person who prepared the said document;

5. I am executing this affidavit to attest to the truthfulness of the foregoing facts and for
whatever legal purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________, in the City of
Meycauayan, Bulacan.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this _______, affiant exhibiting to me his

________ valid until _________.

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