(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)