Republic of the Philippines ]

City of Marikina. ] S.S.

AFFIDAVIT OF DISCREPANCY
(Date of Birth)

I, ________________________________, of legal age, Filipino citizen, __________,

residing at ____________________________________________________________,
Philippines, UNDER OATH, do hereby depose and state THAT:

01. I am a holder of a _______ professional drivers license with no.

_____________by the Land Transportation Office (LTO) of ___________,
a copy of which is hereto attached as ANNEX A;

02. My date of birth recorded and appearing in my aforesaid drivers license is

__________________ which is erroneous because my correct date of birth
is ________________________ as shown in my birth certificate, copy of
which is hereto attached as ANNEX B;

03. I have this affidavit executed to attest to the truth of the foregoing and for
purposes of reporting the same to the LTO so that my date of birth
erroneously recorded as _______________________ can be corrected to
__________________________ and to request for a replacement or
renewal of my said drivers license bearing my correct date of birth.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this ______ day

of _____________________ in Marikina City, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me on this _____day of _________________

in Marikina City, Philippines. Affiant exhibited as evidence of identity
______________________________________________________

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.