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REPUBLIC OF THE PHILIPPINES )

Batangas City, Philippines ) S.S.

AFFIDAVIT OF DISCREPANCY

I, _____________________, of legal age, married, and with address at


_______________________________, subscribing under oath, state that:

1. I was born on ____________________________ at _____________________.

2. My place of birth as indicated in my Report of Ratings issued by National Board


for Teachers is Lipa City, Batangas.

3. In my birth certificate issued by Philippine Statistics Authority, my birth place was


Rosario, Batangas.

4. I would like to manifest that as per accounts of my parents and upon verification at
the Lipa City Civil Registrar on early 1986, there exist no records of Live Birth of a
child in the name of _______________________ born on
____________________________.

5. I applied for late registration for Certificate of Live Birth at the Municipal Civil
Registrar of Rosario, as it has been my place of residence since 1968.

6. That when I applied for the


_______________________________________________ , I have indicated that
my birthplace was Lipa City, believing that my real birthplace was Lipa City,
Batangas.

7. I recently requested the Civil Service Commission, for a certification and


authentication of my PBET eligibility, unfortunately they declined my request as
there is a discrepancy on the place birth indicated in my Eligibility/Examination
Records submitted. It appears that according to their records my place of birth is
Lipa City which is against the place of birth appearing in my Certificate of Live Birth.

8. For all intents and purposes, my true and lawful place of birth is at Rosario,
Batangas Province.

9. I am executing this Affidavit of Discrepancy 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 _________________ at


Batangas City.

_______________________________
Affiant
Doc No: ___
Page No: ___
Book No: ___
Series of _____

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