Affidavit of Discrepancy of Surname

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI            ) S.S.

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AFFIDAVIT OF DISCREPANCY

 I, SAM L. MILBY, of legal age, Filipino, (single/married/widow) and a resident of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT:

1. I was born on 15th day of the October 1960 to spouses Anna Lerma and John Milby;

2. I have been using the name SAM L. MILBY  in all my documents and transactions;

3. However, when I obtained a copy of my birth certificate, I discovered that my surname appearing thereon was erroneously written as "MELBY";

4. The names “SAM L. MILBY” and “SAM L. MELBY” refers to one and the same person;

5. I execute this Affidavit of Discrepancy of Surname to attest to the truth of the foregoing facts and to explain the discrepancy in my birth certificate with regards my surname.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in Makati City, Metro Manila, Philippines.

____________________ Affiant SSS ID No. _____________

 SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his/her competent evidence of identity by way of __________________ issued at ______________ on __________________.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2013.