REPUBLIC
OF THE PHILIPPINES)
__________________________
) Sc.
I, WWW
WWW, of legal age, single, and with address at 808 Maganda St., May Lahi,
Manila under oath, state that:
1.
My name is WWW XXX as stated and
registered in my birth certificate issued by the Philippine Statistics
Authority. A copy of my birth
certificate is hereto attached as ANNEX “A” and made an integral part of
this Affidavit;
2.
In my Certificate of Live Birth as
recorded in the Office of the Civil Registrar of May Lahi, Manila, Philippines,
my surname was erroneously written as "XYX" instead of my true
and correct surname of "XXX";
3.
My true surname name is "XXX",
as appearing in all my pertinent records including scholastic records and all
identification cards, including my Philippine passport. Copy of my Philippine passport is hereto
attached as Annex “B” and made an integral part of this Affidavit;
4.
WWW XXX and WWW XYX refer to one and the same
person, the herein Affiant; and
5.
I am executing this Affidavit of
Discrepancy to attest to the truth of the foregoing facts and to explain the
discrepancy in my Certificate of Live Birth.
IN
WITNESS WHEREOF,
I hereunto affix my signature this _________________ at __________________________.
WWW
XXX
Affiant
Signed
in the presence of:
_______________________________ ______________________________
JURAT
SUBSCRIBED
AND SWORN to
before me this _______________ at _____________, Affiant exhibiting to me his/her Competent
Identification Card: ______________________, issued on _________________ at
________________.
NOTARY
PUBLIC
Doc
No. _______;
Page
No. ______;
Book
No. ______;
Series
of 2019.
