Affidavit of Discrepancy - Sample
Affidavit of Discrepancy - Sample
Affidavit of Discrepancy - Sample
) S.S.
I, _______, of legal age, Filipino, married, and a resident of _____________, having been duly
sworn in accordance with law, hereby depose and state:
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
_____________.
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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