This affidavit of discrepancy was sworn by [name redacted] to clarify inconsistencies in records of their date of birth. According to their birth certificate and PSA birth certificate, they were born on [date redacted] in [place redacted], Philippines. However, another document lists their date of birth as [date redacted]. This affidavit aims to affirm the truth of their birth date as recorded in their birth certificate and PSA birth certificate.

1. REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S.
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AFFIDAVIT OF DISCREPANCY
I, ________________________, of legal age, married, Filipino, and a resident of
___________________________,after having been duly sworn to in accordance with law, hereby
depose and states:
1. That in my Certificate of Live Birth as recorded in the Office of the Civil Registrar
of __________________ City, Philippines and my PSA Birth Certificate, I was born on
___________at ______________________, Philippines;
2. That in my ________________________, I was born on ________________at
__________________, Philippines;
3. That in truth and in fact, I was born on ______________ at __________________,
Philippines and as evidenced by my Certificate of Live Birth and PSA Birth Certificate;
4. That I am executing this Affidavit of Discrepancy to attest to the truthfulness of
the foregoing facts and to explain the discrepancy in my Certificate of Live Birth, PSA Birth
Certificate and ________________ as regards my date of birth.
IN WITNESS WHEREOF, I hereby affixed my signature this ___________________ in
the City of ____________, Philippines.
PEM _______________________________
Affiant
SUBCRIBED AND SWORN TO before me this ___________________ in
_________________, Philippines, affiant exhibiting to me his/her competent evidence of
identity by way of I.D. No.___________issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;

2. Series of 2022.