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REPUBLIC OF THE PHILIPPINES
[Province/City/Municipality]) S.S.
AFFIDAVIT OF DISCREPANCY
I, [Full Name], of legal age, [civil status], [nationality], and presently residing at [Complete Address], after having been duly sworn to in accordance with law, depose and state:
That my full and correct name is [Full Name as Appearing in Primary Documents];
That I have discovered a discrepancy in my records, as follows:
[State the Incorrect Entry] appearing in [Document with Error, e.g., Birth Certificate, Passport, School Records]
[State the Correct Entry] appearing in [Document with Correct Information, e.g., Government ID, Employment Records]
That despite this discrepancy, both names refer to one and the same person, and I have been using these names interchangeably due to [state reason, e.g., clerical error, oversight, misspelling, difference in naming conventions]; and
That I am executing this affidavit to attest to the discrepancy and to certify that all documents, records, and transactions under these names pertain to me, and for any legal purpose it may serve, including but not limited to [e.g., correction of records, passport application, employment, banking, government transactions].
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of [month], [year], at [place of execution].
[Signature]
[Full Name]
Affiant
SUBSCRIBED AND SWORN TO before me in the City/Municipality of [location], this ___ day of [month], [year], by affiant who has satisfactorily proven his/her identity through [Government ID type and number], issued on [date] and expiring on [date], that he/she is the same person who personally signed before me the foregoing Affidavit of Loss and acknowledged that he/she executed the same.
NOTARY PUBLIC
Doc No. ____;
Page No.____;
Book No. ___;
Series of [YEAR].