REPUBLIC OF THE PHILIPPINES)
Makati City ) SS.
AFFIDAVIT OF DISCREPANCY
I, JUAN DE B. LA CRUZ, of legal age, married, and with address at ______________________________________________________, under oath, state:
1. THAT my name is JUAN B. DE LA CRUZ as stated and registered in my birth certificate issued by office of the Civil Registry of ______________________. A copy of my birth certificate is hereto attached as ANNEX “A”;
2. THAT the name JUAN B. DE LA CRUZ also appears in my passport which was issued based on the data appearing in my birth certificate. A copy of the page of my passport where my name and picture appears is hereto attached as ANNEX “B”;
3. THAT since childhood, my friends and acquaintances call me JOHN and thus since then I have been accustomed to using the name JOHN B. DE LA CRUZ in my personal records, transactions and communications;
4. THAT the name JUAN B. DE LA CRUZ and JOHN B. DE LA CRUZ refer to one and the same person, the herein Affiant;
5. 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 _________________ at Makati City.
JUAN B. DE LA CRUZ
SUBSCRIBED AND SWORN to before me this _______________ at Makati City, Affiant exhibiting to me his Passport bearing No. ______________________________ issued at ______________ on _________________.
Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of ________.