REPUBLIC OF THE PHILIPPINES)

City of Manila
) SS.
x-----------------------------------------------x

AFFIDAVIT OF DISCREPANCY IN NAME

I, Juan de la Cruz, of legal age, single, Filipino and a resident of Block 10 Lot 1, MWSS
Compound, San Hilarion St., Del pan Tondo, Manila, Philippines, under oath, hereby depose and
state that:
1. My name is JUAN DE LA CRUZ as stated and registered in my Certificate of Live Birth
issued by the office of the Civil Registry of Manila City, Philippines. A copy of my birth
certificate is hereto attached as ANNEX A;
2. I have been using the name JUAN DE LA CRUZ in my personal records, transactions
and communications;
3. When I requested for my Baptismal Certificate, attached hereto as ANNEX B, in Tondo
Church last October 29, 2016, as it was required for the application of marriage license,
it appeared that my birth name was erroneously written by as JOHN DE LA CRUZ
instead of JUAN DE LA CRUZ ;
4. I am executing this Affidavit of Discrepancy to attest to the truth of the foregoing facts
and to explain the discrepancy in my Certificate of Live Birth and Baptismal Certificate
as regards to my name;
5. Further, I am declaring that from this date hereon I would be using my true and correct
name JUAN DE LA CRUZ in all my papers, records and other documents.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 November 2016

Manila City , Philippines.

at

Juan De la Cruz
AFFIANT

JURAT
SUBSCRIBE AND SWORN to before me, this 17 November 2016, by the Affiant who is
personally known to me and who exhibited his/her Community Tax Certificate No. 123456
issued at Manila City on 17 November 2016.
Atty. Dana Erika Correa
NOTARY PUBLIC

Doc. No.987654;
Page No. 12345;
Book No.97352;
Series of 2016.