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REPUBLIC OF THE PHILIPPINES)

CITY OF MEYCAUAYAN
)
PROVINCE OF BULACAN
) S.S.

AFFIDAVIT OF DISCREPANCY
I, name, Filipino Citizen, of legal age, and with postal address Lot
______address___________________, under oath, states that:
1. My true date of birth is ____________, as stated and registered in my
Philippine Passport issued by the Department of Foreign Affairs, and my
Drivers License issued by the Land Transportation Office. (A copy of
Philippine Passport and Drivers License of __________, is attached hereto as
Annex A and B, respectively);
2. However, in my Certificate of Birth the date _______ was mistakenly
recorded as my date of birth. (A copy of the Birth Certificate of __________, is
attached hereto as Annex C);
3.
As such, the date ___________ and not my true date of birth
________ appears in my Certificate of Birth;
4.
My true date of birth is _____________, as what appears in my
Philippine Passport issued by the Department of Foreign Affairs, and my
Drivers License issued by the Land Transportation Office;
5. I am executing this Affidavit to attest to the truth of the foregoing
facts and to use the same for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I hereunto affixed my signature this 6th day
of April 2015 at _______________, Philippines.
_____________________
Affiant
SUBSCRIBED AND SWORN to before me this 6th day of April 2015 at
________________, affiant exhibiting to me his Drivers License with Number
___________________, bearing his photograph and signature.

NOTARY PUBLIC
Doc. No. __;
Page No. __;
Book No. II;
Series of 2015.