AFFIDAVIT OF DISCREPANCY

(ONE AND THE SAME PERSON)

I, _________________________, Filipino, single, of legal age, with address at 334

Rosas street, Santiago, Santa Ana, Pampanga, after having been duly sworn to in
accordance with the law hereby depose and say:

1. The Certificate of Live Birth issued __________________ at

__________________ indicates my names as _____________________.

2. On the other hand, I have been using the name _____________________ on my

school records and employment documents.

3. In the _______________ issued by my ___________________, my name is

indicated as ________________________.

4. Both names/documents pertain to one and the same person.

5. I am executing this affidavit to attest to the truth and for whatever legal purposes
it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this

_________________________ at the _________________________.

_________________________________

Signature of Affiant over Printed Name