REPUBLIC OF THE PHILIPPINES)

Baguio City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, ________________, of legal age, single, and with address at ________________,

under oath, state:

1. THAT my name is ________________ as stated and registered in my

birth certificate issued by office of the Civil Registry of Davao City. A copy of my
birth certificate is hereto attached as ANNEX “A”;

2. THAT since childhood, my friends and acquaintances call me

________________ and thus since then I have been accustomed to using the name
________________ in my personal records, transactions and communications;

3. THAT the name ________________and ________________ refer to one and

the same person, the herein Affiant;

4. 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 22nd day of January

2012 at Davao City.

________________
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of January 2012 at

Davao City, Affiant exhibiting to me his TIN # 259-159-192-000 issued at Davao
City on January 31, 2008.

Atty. ________________
Notary Public until
Roll No.
Doc No. _________ IBP No.
Page No. ________ PTR No.
Book No. ________ TIN-
Series of 2012 MCLE No