Affidavit of Discrepancy and One and the Same Person
Republic of the Philippines · Template v0.2.0
REPUBLIC OF THE PHILIPPINES )
MAKATI CITY ) S.S.
SWORN STATEMENT
I, Maria Luz Santos, Filipino, of legal age, single, and residing at 100 Ayala Avenue, Makati City 1226, after having been duly sworn in accordance with law, depose and state:
1. I am the person to whom both records identified below refer, and I personally know my own identifying facts.
2. The discrepancy concerns Maria Luz Santos and the field “Complete name.” PSA-issued Certificate of Live Birth, issued by Philippine Statistics Authority / City Civil Registry Office of Manila, reference Registry No. 1990-12345, issued July 10, 2026, states the Complete name as “MARIA LUZ REYES SANTOS.”
3. Professional Identification Card, issued by Professional Regulation Commission, reference PIC ending 4321, issued March 1, 2025, states the Complete name as “MARIA L. R. SANTOS.”
4. I am not relying on an additional inconsistent record beyond the records and evidence expressly identified in this Affidavit.
5. I truthfully assert that the correct entry is “MARIA LUZ REYES SANTOS.” The strongest existing basis is: PSA-certified Certificate of Live Birth, Registry No. 1990-12345, supported by the original local civil-registry entry
6. The other supporting evidence and the fact established by each item are: Current passport shows MARIA LUZ REYES SANTOS; school records consistently show the same complete name
7. The factual history and explanation of the discrepancy are: The shortened middle names appear only on the professional card. I do not know why the issuer abbreviated them, and I make no claim beyond what the genuine records show.
8. Based on my personal knowledge and the genuine records identified above, the differently stated entries refer to one and the same person, Maria Luz Santos. I am not using this statement to create an alias, assume another identity, or conceal a contrary record, disqualification, investigation, or dispute.
9. I execute this Affidavit for submission to Professional Regulation Commission for this specific lawful purpose: To support the verified correction of my professional identification record. I request only that the recipient evaluate it with the attached evidence and the recipient's governing process.
10. I understand that this Affidavit does not itself amend, cancel, supersede, or compel acceptance of a civil-registry entry, passport, license, school, employment, benefits, tax, financial, land, transport, court, or other record. Any correction remains subject to the authorized registrar, agency, or court process.
11. I have read and understood this Affidavit. Its material statements are true and complete based on my personal knowledge and the records expressly identified. I understand that a knowingly untruthful material statement under oath for a legal purpose may result in criminal and other liability.
CIVIL-REGISTRY RECORD
The civil-registry record is held by City Civil Registry Office of Manila and is identified as follows: Certificate of Live Birth, Registry No. 1990-12345, complete-name entry. The civil-registry entry is correct and is relied on as the primary record; no civil-registry correction is sought.