REPUBLIC OF THE PHILIPPINES )

PROVINCE OF _______________ ) SS
MUNICIPALITY OF ___________ )

AFFIDAVIT OF DISCREPANCY
I, ________, of legal age, married, and a resident of ________, Quezon City, Metro
Manila, Philippines, after having been duly sworn to in accordance with law hereby
depose and say:
1.

That I was born in ________ on ________ with spouses ________ and ________ as
my legitimate parents. Attached please find photocopy of my aforesaid
certificate of live birth;

2.

That sometime in 1986, I applied for work as a security guard with a certain
security agency which secured for me my license as a security guard as well
as secure my Social Security Number ________ from SSS Provincial Office of
________ on ________;

3.

That I have recently discovered a discrepancy between my certificate of live

birth and my personal record with the Social Security System relative to my
date of birth. It appears in my personal record with the System that my date
of birth is ________ which date is different from what appears or recorded in
my above-mentioned certificate of live birth, Annex A hereof;

4. That I am executing this affidavit to attest to the truth of the foregoing

circumstances and for the purpose of informing the authorities concerned so
that my record with the Social Security System will be accordingly corrected
to contain the true date of my birth..
IN WITNESS WHEREOF, I have hereunto set my hand this __ th day of January,
________, at Quezon City, Metro Manila, Philippines.

(Signature over Printed Name)

Affiant
SUBSCRIBED AND SWORN to before me this ____ th day of ________, 200__
in _____________, Affiant exhibited to me his Community Tax Certificate No.
________ issued at ______, on ________.

Notary Public
Until December 31, 20__
IBP No. __________________
PTR No. __________________
Doc. No. : _____;
Page No. : _____;
Book No.: _____;
Series of 200__.