(Affidavit of Discrepancy Date of Birth)

Republic of the Philippines)

Province of________________) S.S.
City/Municipality of____________)
x-----------x
AFFIDAVIT OF DISCREPANCY
I,___________, of legal age,(single / married / widow),Filipino and a resident of_____________,
Philippines, having been duly sworn in accordance with law, hereby depose and state:
That in my Certificate of Live Birth as recorded in the Office of the Civil Registrar of
____________City,Philippines and Secondary Student Permanent Record at___________High
School, it is stated that I was born on 21 May 1970 at____________, Philippines;
That my relatives, acting on the honest belief that I was born on 21 May 1971, had used 21 May
1971 as my birth date in all pertinent school records when they processed my enrollment
at__________in ____________;
That when I filled up my voter's registration record required by the Commission on Election
last___________, I had inadvertently and erroneously written the date of my birth as 21 May 1971
instead of 21 May 1970;
That I am executing this Affidavit of Discrepancy to attest to the truth of the foregoing facts and to
explain the discrepancy in my Certificates of Live Birth,Secondary Student Permanent Record
Transcript of Records and Voter Registration Form as regards to my date of birth;
Further, I am declaring that from this date hereon I would be using my true and correct date of
birth of 21 May 1970 in all my papers, records and other documents.
IN WITNESS WHEREOF, I have hereunto set my hand this___________, at___________,
Philippines.
Affiant
(JURAT)