Affidavit of Discrepancy - Sample

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REPUBLIC OF THE PHILIPPINES )

) S.S.

AFFIDAVIT OF NAME DISCREPANCY

I, _______, of legal age, Filipino, married, and a resident of _____________, having been duly
sworn in accordance with law, hereby depose and state:

1. THAT my maiden name is __________ as stated and registered in my Certificate of Live


Birth issued by the Office of the Civil Registrar of Bacolod City. A certified true copy issued
by the Philippine Statistics Authority is hereto attached as Annex “A”,

2. THAT on _____, I was married to __________ as shown in our Certificate of Marriage dated
____, a copy of which is attached as Annex “B”. Since then, I started using the name
_______;

3. THAT my true and correct name, _________ appears on my PAG-IBIG Card (Annex “C”),
COMELEC ID (Annex “D”), and Community Quarantine ID (Annex “E”) issued by Barangay
Batasan Hills, Quezon City;

4. THAT on the other hand, my name was erroneously typed as _______in my Philhealth ID
(Annex “F”), Quezon City Health Department ID (Annex “G”), PRC ID (Annex “H”) and
Senior Citizen’s ID (Annex “I”);

5. THAT the names ______ and ______ refer to one and the same person, the herein Affiant;

6. 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 __ day of September 2020 in the City of
_____________.

---
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of September 2020 at the City of
___________, Affiant having exhibited to me her Philippine Passport No. ________ issued on
_____________at ________________ and valid until ______________.

Doc No.
Page No.
Book No.
Series of 2020

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