AFFIDAVIT OF DISCREPANCY IN NAME FORMAT

REPUBLIC OF THE PHILIPPINES)

______ City                             ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, ________________, of legal age, single, and with address at __________________, under oath, state:

1.    THAT  my name is ________________ as stated and registered in my birth certificate issued by office of  the Civil Registry of               City. A copy of my birth certificate is hereto attached as ANNEX “A”;

2.    THAT since childhood, my friends and acquaintances call me Rain and thus since then I have been accustomed to using the name ______________ in my personal records, transactions and communications;

3.    THAT the name ________________ and _____________ refer to one and the same person, the herein Affiant;

4.    THAT I 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, I hereunto affix my signature this ____day of _________ at ____________.

                                                                                   _______________

                                                                                          Affiant

SUBSCRIBED AND SWORN to before me this ________day of __________ at _________, Affiant exhibiting to me his ________________ issued at ________ on ________________.

          Atty. Juan Dela Cruz

Roll No. 9195

Doc No. _________                                                  IBP No. 

Page No. ________                                                  PTR No. 

Book No. ________                                                   TIN- 

Series of 2012                                                            MCLE No.