Affidavit of Discrepancy - Middle Name

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Republic of the Philippines ]

City of Muntinlupa ]

AFFIDAVIT OF DISCREPANCY
(Middle Name)

I, PEDRITO SUMIRAN CONSEBIDO, of legal age, Filipino citizen, residing at 34


Wintergreen Street, South Greenheights Village, Putatan, Muntinlupa City, Philippines, UNDER
OATH, do hereby depose and state THAT:

01. I am a holder of a non-professional driver’s licence with no. N02-80-021325


issued by the Land Transportation Office (LTO) of Muntinlupa City, a copy of
which is hereto attached as Annex A”

02. My middle name recorded and appearing in my aforesaid driver’s license is


SUMIBAN which is erroneous because my correct middle name is SUMIRAN as
shown in my birth certificate which is hereto attached as Annex B:

03. I have this affidavit executed to attest to the truth of the foregoing and for
purposes of reporting the same to LTO so that my middle name erroneously
recorded as SUMIBAN can be corrected to SUMIRAN and to request for the
renewal of my said driver’s license bearing my correct middle name.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this ____ day of


January 2019 in Muntinlupa City, Philippines.

PEDRITO S. CONSEBIDO
---------------------------------
Affiant

SUBSCRIBED AND SWORN to before me on this ____ day of January, 2019 in


Muntinlupa City, Philippines. Affiant exhibited as evidence of identity his Tax Identification No.
Card 101-905-585-000 issued on April 10, 2000.

NOTARY PUBLIC

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of _2019

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