REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)
x---------------------------------------x
AFFIDAVIT OF DISCREPANCY ON NAME
I, ______________(name of affiant)__________________, Filipino, of legal age, [single]/[married
to ___________(name of spouse)_______], and a resident of ___________(address of
affiant)____________, after having been duly sworn in accordance with law, hereby depose and
state:
1. That on _____(date)________, I was issued a Philippine Passport with passport
number _____________ in which my true First Name _____(Correct Name)____ was
stated;
2. That before the expiration of the aforementioned passport on _____(date)________, I
had applied with Philippine Embassy in _____________ for the issuance of a new
passport and on _____(date)________,
4. I was issued a new Philippine passport with passport no. _____________________;
5. However, in the said new passport my First Name had been erroneously misspelled as
_____(Misspelled Name)____;
4. That I execute this Affidavit of Discrepancy to attest to the truth of the foregoing facts
and to explain the discrepancy in my Philippine Passport with regards my First Name.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at _____________,
Philippines.
____________(signature)___________
Affiants Name

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent Evidence of
Identity)______ issued by the _________(Government Agency)______ on ___(date)__
at ________(place)_________, bearing his photograph and signature, known to me as the
same person who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

Doc. No. ____

Page No. ____
Book No. ____

Atty ___________________________________________
Notary Public
Commission Serial No. ____________________________
Notary Public for _______(Province/City)______________
Until December 31, 20__

Series of 20__

Office: ______________(address)____________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ; _(Province)_
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__