REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.

AFFIDAVIT OF DISCREPANCY

KNOW ALL MEN BY THESE PRESENTS:

I, ____________________, of legal age, Filipino, married and resident of

_______________, after having been sworn in accordance with law, depose and state:

1. That my name is _____________ as stated in my Passport No. ______________ issued

on _____________ by the DFA NCR East; A copy of my Passport is hereto attached as
“Annex A”
2. That the name __________ appears on Ticket No. ___________ issued by Cebu Pacific
bound to Tokyo, Japan; A copy of the Cebu Pacific Ticket is hereto attached as “Annex B”
3. That on May 9, 2018, right after arriving at the airport I had the employee of TIEZA
check my ticket and informed me that I haven’t paid the corresponding taxes;
4. That on May 9, 2018, while I was checking in my luggage, the person in the check-in
counter informed me that I have already paid my travel taxes when I availed of my ticket
and proceeded to provide me a document of proof that I have already paid the due
taxes;
5. That on May 13, 2018, when I get back from Japan, I have filed a claim for Travel Tax
Refund due to the error committed by the employees of TIEZA; A copy of the Travel Tax
Refund is hereto attached as “Annex C”
6. That the names _____________ and ____________ refer to one and the same person;
7. That I am executing this affidavit to attest to the truth of the foregoing facts and to use
the same for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of June 2018 at
__________________________.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of June 2018 in ______________
City, Philippines, affiant exhibited to me her Passport No. _________ valid until
________________ and Driver’s License No. ________________ valid until October 05, 2021.

Doc No. ____;

Page No. ___;
Book No. ___;
Series of 2018.