Republic of the Philippines )

______________________) S.S.

AFFIDAVIT OF DISCREPANCY

I, ___________________, of legal age, Filipino citizen, married, and a resident of

__________________________, after being duly sworn to in accordance with law, hereby
depose and state that:

1. Since childhood, I have been using the name “_____________________” as it is the

one subsumed in my Birth and Marriage Certificate;

2. However, when I have transacted with the Social Security System (SSS) and with the
Land Transportation Office (LTO) in connection with the issuance of my SSS I.D. and
Driver’s License Card, I have inadvertently misspelled my name to “___________”
instead of the correct one “__________”;

3. Considering the concomitant circumstance indicated on the above, I hereby attest under
oath that the names “__________________” and “_____________________” pertain to
me as one and the same person;

4. Moreover, the erroneous spelling of my First Name was never intentional on my part but
merely a product of inadvertence and of my misapprehension of fact regarding my name
on the above-stated documents/items;

5. That I am executing this affidavit to attest to the truth of the foregoing statement, provide
a clarification as well as secure a rectification of the error or discrepancy mentioned
herein, and for whatever legal intents and purposes it may serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this
_______ day of _____________________________ at
___________________________________.

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _____________________

20______ at ______________________, affiant exhibiting to me her _______________ valid
until _______________ issued by the __________________, which serves as her Competent
Evidence of Identity pursuant to the 2004 Rules on Notarial Practice.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017.