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Republic of the Philippines)

City of ________________)


I, ___________________________, of legal age, Filipino, widow, and a resident of, Km.

7 _____________________, Philippines having been duly sworn in accordance with
law, hereby depose and state:

That I was born to the spouses _______________________ on November 21, 1920 in

_________________________, Philippines;

That however, in my record with the Commission on Elections, my First Name was
erroneously written as "HUWAN" instead of the true and correct name JUAN";

That the name found in the COMELEC ID as HUWAN and the name found in my
PhilHealth ID and Marriage Contract as JUAN refer to one and the same person;

Said discrepancy in the COMELEC ID and in its record is an error done inadvertently;

That I execute this Affidavit of Discrepancy to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this __________________ at

________________________, Philippines.


Signed in the presence of:

SUBSCRIBED AND SWORN TO BEFORE me this ____________________at

__________________, Philippines. Affiant having submitted to me his ________________ ID
with No. ____________________ for identification purposes.