AFFIDAVIT OF DISCREPANCY

I, JUAN DELA CRUZ, of legal age, married, Filipino and a resident of

_____________, Philippines having been duly sworn in accordance with law,
hereby depose and state:

That on _____________, I was issued a Philippine Passport with passport number

_____________ in which my true surname DELA CRUZ was stated;

That before the expiration of the aforementioned passport on _____________, I

had applied with Philippine Embassy in _____________ for the issuance of a new
passport and on _____________, I was issued a new Philippine passport with
passport no. _____________;

However, in the said new passport my surname had been erroneously misspelled
as DELA CRUX;

That I execute this Affidavit of Discrepancy to attest to the truth of the foregoing
facts and to explain the discrepancy in my Philippine Passport with regards my
surname.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at

_____________, Philippines.

Affiant

(JURAT)