Republic of the Philippines

Province of Quirino) S.s.

Municipality of Diffun)

AFFIDAVIT OF DISCREPANCY
I, LILYBETH M. BUREROS, of legal age, Filipino, married and a resident of Gundaway,
Cabarroguis, Quirino after having been duly sworn to in accordance with law, depose and
state THAT:

1. I was born on 4th day of April 1972 to spouses Criselda and Quirino Melchor;

2. I have been using the birthdate FEBRUARY 21, 1972 in all my documents and transactions;

3. However, when I obtained a copy of my birth certificate, I discovered that my date of birth
was “APRIL 4, 1972”;

4. That the Date of birth “APRIL 4, 1972” and “FEBRUARY 21, 1972” refers to the date of
birth of one and the same person;

5. I execute this Affidavit of Discrepancy of Date of Birth 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 13th day of July, 2018 at Diffun,
Quirino.

LILYBETH M. BUREROS
Affiant
BIR ID No. 295-221-504-000

SUBSCRIBED and SWORN TO before me on the date and at the place indicated
below. The affiant exhibited to me his competent evidence of identity as indicated above.

Signed this 13th day of July, 2018 at Diffun, Quirino.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

Notary Public
Until December 31, 2019
Doc. No.354; PTR No. 3218465/ 01-03-2018
Page No.52; Lifetime IBP No. 17396/05-20-2017
Book No. 04; ROLL No. 67812/05-26-2017
Series of 2018. (MCLE Governing Board Order No. s-2008)
Diffun, Quirino