Republic of the Philippines )
City of (Place) ) S.S.
AFFIDAVIT
OF DISCREPANCY
(TO
ESTABLISH SINGLE IDENTITY OF NAMES)
I, (NAME OF AFFIANT), Filipino, of legal age, single/married, with
postal address at (Place of Residence),
after having been sworn to in accordance with law, hereby depose and state:
1. That in
my Certificate of Birth, my middle name was erroneously written as "(ERRONEOUS NAME)" instead of my
true and correct middle name of "(CORRECT
NAME)"
2. That my
true middle name is "(CORRECT NAME)";
as appearing in my (Government-Issued
ID-1) and (Government-Issued ID-2),
a copy of which are hereto attached as Annex “A”;
3. That in
all pertinent documents which I had used, to include that of my Election
Records and GSIS Records, I used my true and correct middle name of "(CORRECT NAME)"
4. That 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,
as regards my true middle name.
5. That I
assumed the name (NAME OF AFFIANT),
when I signed official documents and exercised my professional work in
government;
6. That
the names (ERRONEOUS NAME), as
appearing in my Philippine Passport of (Years
of Passport Validity), and (CORRECT
NAME), as appearing in my government-issued IDs, refer to one and the same
person, which is the undersigned/affiant herein;
7. That I
am executing this Affidavit to clear any discrepancy which may arise from
official documents bearing either name “(ERRONEOUS
NAME)" or “(CORRECT NAME)”.
IN WITNESS WHEREOF, I have hereunto
affixed my signature this (Date) in (Place).
NAME OF
AFFIANT
Affiant
SUBSCRIBED AND SWORN to before me
this (Date) in (Place), with affiant exhibiting to me his (ID Details).
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of _____.
