Anda di halaman 1dari 1

Affidavit of Discrepancy in Name

REPUBLIC OF THE PHILIPPINES)


Makati City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, _____________________, of legal age, married, and with address at


______________________________________________________, under oath, state:

1. THAT my name is ____________________ as stated and registered in my birth


certificate issued by office of the Civil Registry of ______________________. A copy
of my birth certificate is hereto attached as ANNEX A;

2. THAT the name ___________________also appears in my passport which was


issued based on the data appearing in my birth certificate. A copy of the page of
my passport where my name and picture appears is hereto attached as ANNEX
B;

3. THAT since childhood, my friends and acquaintances call me ________and thus


since then I have been accustomed to using the name ____________________in my
personal records, transactions and communications;

4. THAT the name ____________________ and _____________________ refer to one and


the same person, the herein Affiant;

5. THAT 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 affix my signature this _________________ at


Makati City.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Makati City,


Affiant exhibiting to me his Passport bearing No. ______________________________
issued at ______________ on _________________.

Doc No. ________;


Page No. _______ ;
Book No. _______;
Series of ________.