REPUBLIC OF THE PHILIPPINES)

PROVINCE OF DAVAO DEL SUR: S.S.

CITY OF DIGOS
)
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AFFIDAVIT OF DISCREPANCY IN NAME
That I, JANE DELA CRUZ, of legal age, Filipino, single
and a resident of Digos City, after having been duly sworn
to in accordance with law, do hereby depose and say:
1. That my name is JANE DELA CRUZ as stated and
registered in my birth certificate issued by office of the Civil
Registry of Davao City. A copy of my birth certificate is
hereto attached as ANNEX A;
2. That since childhood, my friends and acquaintances
call me Jean and thus since then I have been accustomed to
using the name Jean dela Cruz in my personal records,
transactions and communications;
3. That the name Jane dela Cruz and Jean dela Cruz refer
to one and the same person, the herein Affiant;
4. That 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, we have hereunto set our hands this
9th day of January 2017 at Digos City, Philippines.
JANE DELA CRUZ
Affiant
TIN 283-863-171-000
SUBSCRIBED AND SWORN TO before me this 9th of
January 2017 at Digos City, Philippines.
Doc. No.
Page No.
Book No.
Series of

05;
01;
I;
2017.

ROXANNE Z. JURIAL
Notary Public
Until December 31, 2017
PTR No. 11111
TIN
222222
IBP No. 33333