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Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF DISCREPANCY

I, FELIPE SUMALBAG JUAN, 23 years old, Filipino citizen,


single, and a resident of Barangay Bobon Caarosipan, Camiling,
Tarlac, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:

1. I was born on March 13, 1994 to Spouses Dean Juan and


Divina Sumalbag at Babanuang San Manuel, Isabela;

2. Lately, I went to the Land Transportation Office, Tarlac City


(LTO Tarlac City) to apply for a Student Drivers License and
was required to submit a copy of my Certificate of Live
Birth;

3. When I secured a copy of my certificate of live birth from


the Philippine Statistics Authority (PSA), and after
scrutinizing the same, I discovered that my recorded Name
appearing therein is FELIPE SUMIBCAY JAUN, instead of
FELIPE SUMALBAG JUAN, as appearing in my Police
Clearance with Control No.:20170601019. Also, the name of
my mother was recorded as DIVINA SUMIBCAY, instead
of DIVINA SUMALBAG as recorded in her Certificate of
Live Birth. Hence, the discrepancies;

4. I am executing this Affidavit to attest to the discrepancies in


the entries of my Name and in the Name of my mother in
the said document;

5. Moreover, I am executing this Affidavit to attest to the fact


that the names FELIPE SUMIBCAY JAUN, as recorded in
the above-said Certificate of Live Birth, and FELIPE
SUMALBAG JUAN, as appearing in my Police Clearance
with Control No.:20170601019, refer to one and the same
person, and that is me;

6. Furthermore, I am executing this Affidavit to attest to the


fact that the names DIVINA SUMIBCAY, appearing as the
mother of Felipe Sumibcay Jaun in the above-said
Certificate of Live Birth, and DIVINA ALONZO
SUMALBAG, as recorded in her Certificate of Live Birth,
refer to one and the same person, and that is my biological
mother, Divina Sumalbag Juan;

7. Finally, I am executing this Affidavit to attest to the truth of


the foregoing statements and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my


signature this 1st day of June, 2017 at Camiling, Tarlac, Philippines.

FELIPE S. JUAN
Affiant

SUBSCRIBED AND SWORN to before me on the date and


place indicated above. Affiant exhibited to me his Police Clearance
with Control No.:20170601019 issued by the Camiling Police
Station, Camiling, Tarlac on June 1, 2017.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2017.