AFFIDAVIT OF DISCREPANCY

(SAMPLE ONLY)

REPUBLIC OF THE PHILIPPINES)

___________________________ ) S.S

I, ________________________, of legal age, Filipino, widow, residing at

_______________________, after being sworn in accordance with law, depose and say:

1. That I was married to _________________ on June 20, 1975 by a civil

wedding officiated by __________________. A marriage contract was then
issued under the said civil wedding;
2. That three months thereafter or on September 27, 1975 my husband and I
decided to have a church wedding officiated by
F_________________________. Subsequently a marriage contract had been
issued by virtue of the said church wedding;
3. That I submitted to the Social Security System a marriage contract under my
civil wedding and birth a certificate of my child ______________ as required
to claim the death benefits of my late husband;
4. That under the marriage contract our marriage was celebrated
______________________and under the birth certificates of my child the date
of marriage reflected was on _______________;
5. That the reasons why under the birth certificate of my child the date and place
of marriage mentioned was on ____________________ and not
_______________ as reflected on my marriage contract under my civil
weeding, was the fact that it was the Church wedding date adopted and not the
civil wedding date;

That I executed my affidavit to attest to the truth of the foregoing facts for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_________________________.

______________________
Affiant

Subscribed and sworn to before me this __________________, by

_______________________, with Community Tax certificate no. 22512968 issued on
______________________.

Doc. No. _______

Page No. _______
Book No._______
Series of 200____