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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS

Date:

THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK, INDICATE N/A IF NOT APPLICABLE.
PROVIDING FALSE STATEMENT IS PUNISHABLE BY LAW (R.A. 8239)

Foreign Service Post:

BERNE

GENEVA

AFFIDAVIT OF DISCREPANCY
(ONE AND THE SAME PERSON)

I, _________________________, Filipino, single/married to __________________,


of legal age, with address at _________________________________________________
after having been duly sworn to in accordance with law hereby depose and say:
1)

The ________________ issued on ________________ at _________________


indicates the name/birthday/place of birth of my __________________________
as _________________________.

2)

On the other hand, in the ________________ issued on ___________________


at ____________________ the name/birthday/place of birth of my ___________
is indicated as __________________________.

3)

Both names/documents pertain to one and the same person.

4)

I am executing this affidavit to attest to the truth and for whatever legal purposes
it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this ___________________


___________at the _________________________.

___________________________________________
Signature of Affiant over Printed Name
___________________ )
___________________ ) S.S.
___________________ )
SUBSCRIBED AND SWORN to before me this ________________________ at the

_____________________

affiant having exhibited to me his/ her _______________passport no. ___________________ issued in


__________________on __________________ and valid until ___________________________.
Date: _______________
Service No.: _________
O.R. No.: ___________
Fee Paid: ___________

(seal)

__________________________________
Consul of the Republic of the Philippines

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