Republic of the Philippines)

Province of Isabela)s.s
Municipality of Ilagan)
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AFFIDAVIT OF DISCREPANCY
I, JUAN, of legal age, married, Filipino, and a resident of bambang, manila, zoo after having
been duly sworn to oath in accordance with law, do hereby depose and say:
1. That I am the very same person executing this affidavit;
2. That I gave birth to a child at the manila Provincial Hospital, on August 18, 2011;
3. That in the Certificate of Live Birth of my child, my name stated therein is jana, which is my
nickname, the truth of the matter is my real name is juana;
4. That because of the clerical error committed, I just want to correct that my real name is
Imelda Abon y Domingo and that the name JUANA is only my nickname;
5. That JUANA JUAN are one and the same person;
6. That I am executing this affidavit to attest to the truthfulness of the foregoing that my real
name is Imelda no tjuan ;
7. That this affidavit is executed for whatever legal purpose/s it may serve.
IN WITNESS HEREOF, I have hereunto affix my signature this 31st day of August, 2011 at
Ilagan, Isabela.

juana
Affiant
SUBSCRIBED AND SWORN to before me this 6th day of 31st day of August, 2011 at Ilagan,
Isabela.