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Republic of the Philippines]

Santa Cruz, Laguna ] s.s.

AFFIDAVIT OF DISCREPANCY AND


CORRECTION OF RECORD ENTRY
I MARIZEL SALE BERNALES, of legal age, Filipino, married and resident
of Sitio 2, Brgy, Bagumbayan, Santa Cruz, Laguna after having been sworn in
accordance with law, hereby depose and state that –

1. In my official records and identification cards at the Social Security


System (SSS), Bureau of Internal Revenue (BIR), and Land
Transportation Office (LTO), the spelling of my name appears as
“MARIZEL SALE BERNALES”. On the other hand, in my Certificate of
Live Birth, my name is spelled as “MARIZELLE ISLES SALE”.

2. The person named “MARIZEL SALE BERNALES” in SSS Id. No. 04-
315222-4, BIR T.I.N. Id. 113-941-658-000, and Driver’s License No. D12-05-
003491 on one hand; and the person named “MARIZELLE ISLES SALE”
in the attached Certificate of Live Birth refer to one and the same person:
I,“MARIZEL SALE BERNALES” the undersigned affiant, married Edwin B.
Bernales.

3. Moreover, in my Certificate of Live Birth, the place of my birth was


erroneously recorded as “LUCNA”, when in truth and in fact, I was born
in “LUCENA”. Manifestly on the face of the certificate, this was a clerical
error on the part of the person who recorded the entries in my Certificate
of Live Birth. To set the record straight, I was born in Lucena City in
Quezon Province.

IN WITNESS WHEREFORE, I hereto affixed my signature this 17th day of


September 2016 in Santa Cruz, Laguna.

MARIZEL SALE BERNALES


Affiant

SUBSCRIBED AND SWORN to before me this 17th day of September 2016


by the affiant who exhibited to me her above-mentioned identification cards
and birth record.

WITNESS MY HAND AND NOTARIAL SEAL this 17th day of September


2016 in Santa Cruz, Laguna.

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