REPUBLIC OF THE PHILIPPINES )

) S.S.
PROVINCE OF LAGUNA )

AFFIDAVIT OF DISCREPANCY
(ONE AND THE SAME PERSON)

I, MATEO., 43 years of age, married, Filipino and a resident of Brgy. San

Buenaventura, San Pablo City, under oath states, THAT:

1. That my name is MATEO in my Voter’s I.D.;

2. That on the other hand, when I secured a copy of my Certificate of Live Birth, the
name erroneously indicated was “MATEO”;

3. That my correct and true name is “MATEO.” and I have long been known and
has long been using said name in my school records and other legal documents;

4. That both names “MATEO.” and “MATEO PUYAT.” pertain to one and the same
person;

5. That this affidavit is executed for the purpose of the processing of the
PHILHEALTH of my wife Leticia who is due to give birth anytime today, May 28,
2018;

6. I have executed this affidavit to attest to the foregoing facts and for whatever
legal purposes this may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature

this 28th day of May 2018 in the City of San Pablo, Laguna.

MATEO.
VIN:
Affiant

SUBSCRIBED AND SWORN to before me this 28th day of May 2018 in the City
of San Pablo, Laguna. Affiant exhibited to me his valid identification card with picture. I
further certify that I personally examined the affiant and I am fully satisfied that he freely
and voluntarily executed his statement and understood fully the contents thereof.

Notary public