Anda di halaman 1dari 1

Republic of the Philippines ]

Santa Cruz, Laguna ] s.s.

AFFIDAVIT OF DISCREPANCY

I, EDUARDO GALLO LAM, of legal age, Filipino, and resident of Brgy. Santisima
Cruz, Santa Cruz, Laguna, after having been sworn in accordance with law, hereby
depose and state that –

1. I am a member of the Social Security System (SSS) of the Philippines. In my SSS


I.D. and records, my name appears as EDUARDO CHING GALLO since I have
customarily used this name for a long time.

2. In my birth certificate, my name appears as EDUARDO GALLO LAM.

3. I hereby certify and affirm that the names “EDUARDO GALLO LAM” and
“EDUARDO CHING GALLO” refer to one and the same person, the undersigned.

4. I executed this affidavit to attest to the truth of the foregoing facts and for
whatever lawful purposes this may serve.

IN WITNESS WHEREFORE, I hereto affixed my signature this _______ day of


___________________ 2016 in Santa Cruz, Laguna.

EDUARDO GALLO LAM


Affiant

SUBSCRIBED AND SWORN to before me by the affiant with


_______________________I.D. No. ___________________ issued on _________________
in ________________________.

Doc. No. _____; A T T Y. E M M A N U E L E . S A N D I C H O


Page No._____; NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016
Book No._____; NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA
Series of 2016. PER NOTARIAL COMMISSION SP. PROC. NO. 164(15)
IBP O.R. No. 995689, 04 January 2016, Laguna Chapter
PTR O.R. No. 2967138, 04 January 2016, Laguna
Roll No. 42246, admitted to practice law on 9 May 1997
MCLE Compliance No. V-0015412, dated 6 March 2016

Anda mungkin juga menyukai