REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS Date:

THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE STATEMENT IS PUNISHABLE BY LAW (R.A. 8239)

Foreign Service Post: BERNE GENEVA

AFFIDAVIT OF DISCREPANCY
(ONE AND THE SAME PERSON)

I, , Filipino, single/married to ,
of legal age, with address at
after having been duly sworn to in accordance with law hereby depose and say:

1) The issued on at
indicates the name/birthday/place of birth of my
as .

2) On the other hand, in the issued on

at the name/birthday/place of birth of my
is indicated as .

3) Both names/documents pertain to one and the same person.

4) I am executing this affidavit to attest to the truth and for whatever legal purposes
it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this

at the .

Signature of Affiant over Printed Name

)
) S.S.
)

SUBSCRIBED AND SWORN to before me this at the

affiant having exhibited to me his/ her passport no. issued in
on and valid until .

Date:
Service No.:
O.R. No.: (seal)
Fee Paid: Consul of the Republic of the Philippines