REPUBLIC OF THE PHILIPPINES )

Province of Cavite
Trece Martires City

) S.S.
)

AFFIDAVIT OF DISCREPANCY
I, ___________________, of legal age, widow, Filipino and a resident of
___________________________________, having been duly sworn in accordance with law,
hereby depose and state:
1. That in my Certificate of Live Birth as recorded in the National Statistics Office (NSO), it is
stated that I was born on 25 October 1952 at ________________;
2. That in the records of the Social Security System (SSS), Commission on Election (COMELEC)
and Office of the Senior Citizens Affairs (OSCA), it is stated that I was born on 27 October 1953
at the same address above-stated;
3. That I am executing this Affidavit of Discrepancy to attest to the truth of the foregoing facts and
to explain the discrepancy in my SSS record, as regards to my date of birth;
4. Further, I am declaring that from this date hereon I would be using my true and correct date of
birth of 25 October 1952 in all my papers, records and other documents.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________

at _______________________, and to request the SSS, COMELEC and OSCA to grant
this
Affidavit
of
Discrepancy.

________________________
Affiant
ID No.

SUBSCRIBED AND SWORN to before me, this ___________________, with affiant

exhibiting her valid Identification Card issued on 29 January 2015 at Mendez, Cavite.

NOTARY PUBLIC
Doc. No. : ________;
Page No. : ________;
Book No. : ________;
Series of 2015.