Affidavit of Discrepancy Surname Family Name

(Affidavit of Discrepancy Surname Family Name)

Republic of the Philippines)

Province of__________________) S.S.
City/Municipality of____________)
x - - - -- - - - - - - x

AFFIDAVIT OF DISCREPANCY

I,JUAN DELA CRUZ, of legal age, married, Filipino and a

resident of____________, Philippines having been duly
sworn in accordance with law, hereby depose and state:

That on ____________, I was issued a Philippine Passport

with passport number_____________in which my true surname
DELA CRUZ was stated;

That before the expiration of the aforementioned passport

on ___________, I had applied with Philippine Embassy
in____________for the issuance of a new passport and
on___________,I was issued a new Philippine passport with
passport no.____________;

However, in the said new passport my surname had been

erroneously misspelled as "DELA CRU" X

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
surname.

IN WITNESS WHEREOF, I have hereunto set my hand

this___________,at___________, Philippines.

Affiant

(JURAT)