Republic of the Philippines }

Makati City } §§

AFFIDAVIT OF DISCREPANCY

I, FLORY DHEL GALGUERRA MARIGONDON, of legal age, Filipino and

with postal address at 4336 L. Bernardino St., Gen. T De Leon, Valenzuela City,
after having been duly sworn to in accordance with law, do hereby depose and
say:

1. My name is __________________________ as stated and registered in

my Certificate of Live Birth issued by the National Statistics Office under Local Civil
Registry No. __________________________. A copy of my Certificate of Live Birth is
attached hereto as Annex “A”;

2. The name also appears in my passport which was issues based on

the data appearing in my birth certificate. The bio-page of my passport is attached
hereto as Annex “B”;

3. However, in the __________________________dated

__________________________ issued by __________________________, my name
was erroneously reflected to be __________________________

4. For all intents and purposes, both names refer to one and the same
person;

5. I am executing this Affidavit of Discrepancy to attest to the truth of

the foregoing facts and to explain the discrepancy in my
__________________________, as regards the correct spacing and spelling of my
first name.

___________________________________________
Affiant

SUBSCRIBED AND SWORN to before me this __________________ at

__________________________, affiant exhibiting to me his
__________________________issued in __________________________and expiring
__________________________as competent evidence of her identity.

NOTARY PUBLIC

Doc. No. _____

Page No. _____
Book No. _____
Series of 2018