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Republic of the Philippines)

Province of _________________) S.S.

City/Municipality of _________________)

I, Milagros R. Cabangon, of legal age, married, Filipino and a resident of 1536 Bo. Kapampangan,
Philippines, having been duly sworn in accordance with law, hereby depose and state.
That in my Certificate of Live Birth as recorded in the Office of the Civil Registrar of
___________________ City, Philippines, it is stated that I was born on 21 September 1954 at
___________________, Philippines;
That my parent, acting on the honest belief that I was born on 21 September 1954, but had used
27 September 1954 as my birth date in all pertinent school records, office records and marriage
That I am executing this Affidavit of Discrepancy to attest to the truth of the foregoing facts and
to explain the discrepancy in my Certificates of Live Birth, Permanent Record, Transcript of
Records and Voter Registration Form as regards to my date of birth;
Further, I am declaring that from this date hereon I would be using my true and correct date of
birth of 21 September 1954 in all my papers, records and other documents.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________________________,
at _____________________, Philippines.