REPUBLIC OF THE PHILIPPINES )

Antipolo City ) SS.

Rizal Province )

AFFIDAVIT OF DISCREPANCY IN NAME

I, MA. RITA V. ALBANO, of legal age and with postal address at 10 C. Lawis
Extension, Barangay San Isidro Antipolo City, Philippines, under oath, state:

1. My name is MA. RITA V. ALABANO as stated and registered in my birth

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

2. The name MA. RITA V. ALABANO appears in my Senior Citizen

Identification Card which was issued based on the data appearing in my
birth certificate. A copy of the page of my Senior Citizen ID where my name
and picture appear is hereto attached as ANNEX “B”.

3. On the other hand, in my PERAA Pension Plan issued on _________________

at _____________________ my true and correct name, MA. RITA V. ALBANO,
is indicated as MARITA V. ALBANO.

4. The name MA. RITA V. ALBANO and MARITA V. ALBANO refer to one and
the same person, the herein Affiant.

5. I am executing this Affidavit to attest to the truth of the foregoing facts; to

cause the correction of my name appearing in the records of PERAA
Pension Plan to MA. RITA V. ALBANO; and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

_________________ at Antipolo City.

MA. RITA V. ALBANO

Affiant

SUBSCRIBED AND SWORN to before me this ___________________ at

Antipolo City, Affiant exhibiting to me her Senior Citizen Identification Card No.
___________________________ issued at _______________ on _________________.

NOTARY PUBLIC

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of ________.