Affidavit of Discrepancy

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REPUBLIC OF THE PHILIPPINES | S. S.

DONE: IN THE ____________________ |

AFFIDAVIT OF DISCREPANCY

I, _____________________, of legal age, married, Filipino citizen, and with address at


_______________________, Philippines, after being sworn in accordance with law, hereby depose and
state—

1. I am the daughter of ____________________ who died on _______________________;

2. The true and correct name of my father is __________________ as appearing in his


Certificate of Death and in my Certificate of Live Birth issued by the Office of the Civil
Registrar of __________________, my father’s first name was written as
“__________________”;

3. However, in my Marriage Contract issued by the Office of the Civil Registrar of


___________________, his first name was written as “____________________” instead of
“__________________”. There was a typographical or clerical error in the spelling of the name
of my father;

4. The names "_______________", and “_____________________” refer to one and


the same person, no other than my father;

5. I attest to the truth of the foregoing statements to the best of my own personal knowledge and
upon authentic documents or records. I am executing this Affidavit of Discrepancy to support my
application of Death Claim with the _________________________, and for all other lawful intents and
purposes it may serve.

IN WITNESS WHEREOF, I set my hand this ________ day of _______________ at


____________________, Philippines.

________________________
Affiant
________________________________

SUBSCRIBED AND SWORN to before me, a Notary Public for and in


___________________, this _______________ day of _________________ at
_________________________, Philippines, Affiant personally appeared before me and identified by
competent evidence and proof of her identity through her government-issued ID as indicated below
his name and signature.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2023.

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