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Affidavit of Discrepancy in Name: Affiant Philhealth XXXXXXXXXXXXXX

This affidavit establishes that the affiant's legal name as registered on their birth certificate is xxxxxxxxxxxxx, but they are commonly known as xxxxx. It also states that xxxxxxxxxxxx was mistakenly added as a suffix to their name on their POEA register. The affiant confirms that xxxxxxxxxxxxx and xxxxxxxxx both refer to themselves as the person signing this affidavit to clarify their name.

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JAYAR MENDZ
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1K views2 pages

Affidavit of Discrepancy in Name: Affiant Philhealth XXXXXXXXXXXXXX

This affidavit establishes that the affiant's legal name as registered on their birth certificate is xxxxxxxxxxxxx, but they are commonly known as xxxxx. It also states that xxxxxxxxxxxx was mistakenly added as a suffix to their name on their POEA register. The affiant confirms that xxxxxxxxxxxxx and xxxxxxxxx both refer to themselves as the person signing this affidavit to clarify their name.

Uploaded by

JAYAR MENDZ
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Calamba City, Laguna ) S. S.

AFFIDAVIT OF DISCREPANCY IN NAME

I, xxxxxxxxxxxxxxxxxxxx, Filipino, single, of legal age and


a resident of xxxxxxxxxxxxxxxxxxxx, Calamba City, Philippines,
after having been duly sworn to in accordance with law, do hereby
depose and say:

1. THAT my name is xxxxxxxxxxxxxxxxxxx as stated and


registered in my birth certificate issued by office of the Civil
Registry of Calamba City;

2. THAT since childhood, my friends and acquaintances call


me xxxxx as my nickname and;

3. THAT ‘’xxxxxxxxxx’’ was erroneously included in my POEA


Register as my suffix name;

3. THAT the name xxxxxxxxxxxxxxx and


xxxxxxxxxxxxxxxxx refer to one and the same person, the herein
Affiant;

4. THAT I am executing this Affidavit to attest to the truth


of the foregoing facts and to use the same for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my


signature this 21st day of October 2019 at Calamba City, Laguna,
Philippines.

xxxxxxxxxxxxxxxxx
Affiant
Philhealth xxxxxxxxxxxxxx

SUBSCRIBED AND SWORN TO before me this 21st day of


October 2019 at Calamba City, Laguna, Philippines.
xxxxxxxxxxxxxxxxx

Notary Public
Doc. No. ______;
Until December 31, 2019
Page No.______; PTR No. xxxxxxxxxx/January 3, 2019
Book No.______; IBP No. xxxxxxxxxxx/January 3, 2019
Series of 2019. ROLL NO. xxxxxxxxxxxxxxxx
MCLE Compliance No.
xxxxxxxxxxxxxxxxxxx

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