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REPUBLIC OF THE PHILIPPINES )

Cauayan City ) S.S

AFFIDAVIT OF DISCREPANCY IN NAME

I, Herson Gamboa Marcos, of legal age, married to _____________________ and


with address at ___________________________________, Philippines having been
duly sworn in accordance with the law, hereby depose and state:

1. That my name is Herson Gamboa Marcos.

2. That since childhood, my friends and acquaintances call me Herson and


thus, since then I have been accustomed to using the name Herson Gamboa
Marcos in my personal records;

3. That when I was applying for an insurance under my name, the insurance
company required me to submit my birth certificate issued by the Philippine
Statistics Authority (PSA) however I found out that my name on the birth
certificate was Merson Gamboa;

4. That the name Herson Gamboa Marcos and Merson Gamboa refer to one
and the same person, the herein affiant;

5. That I am executing this affidavit to attest to the truth of the foregoing


facts and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 17th day of


December, 2018 at Cauayan City.

HERSON GAMBOA MARCOS


Affiant

SUBSCRIBED AND SWORN to before me this 17th day of December 2018 at Cauayan
City, Isabela, Affiant exhibiting to me his ___________________________ issued at
________________________ on ______________________ 20 ___.

ATTY. CHRISTINE JOY D. PRESTOZA


Notary Public

Doc. No. _______


Page No. _______
Book No. _______
Series of 2018