REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO
) S.S.
x ---------------------x

AFFIDAVIT OF DISCREPANCY DATE OF BIRTH

I, EDITHA JIMENA AGILLES, of legal age, married, Filipino and a resident of
Brgy. Balantang, Jaro, Iloilo City, Philippines, after having been duly sworn in
accordance with law, hereby depose and state:
That in my Certificate of Live Birth as recorded in the Office of the Civil Registrar
of Iloilo City, Philippines, Service Record at Barotac Nuevo National Comprehensive
High School (BNNCHS) Record, PAG-IBIG, and Government Service Insurance System
(GSIS), Philippine Health Insurance Corporation (PHIC), it is stated that I was born on
September 16, 1953 at Brgy. Tabuc Suba, Jaro, Iloilo City, Philippines;
That my relatives, acting on the honest belief that I was born on September 16,
1953, had used September 16, 1953 as my birth date in all pertinent documents relative
to employment and other transactions;
That when I filled up my voter's registration record required by the Commission
on Election last May 2010, I had inadvertently and erroneously written the date of my
birth as September 16, 1953 instead of March 1, 1953;
That I am executing this Affidavit of Discrepancy to attest to the truth of the
foregoing facts and to explain the discrepancy in my Certificates of Live Birth, Service
Record at Barotac Nuevo National Comprehensive High School (BNNCHS) Record,
PAG-IBIG, Government Service Insurance System (GSIS), Philippine Health Insurance
Corporation (PHIC) and Voter Registration Form as regards to my date of birth
Further, I am declaring that from this date hereon I would be using my true and
correct date of birth of March 1, 1953 in all my papers, records and other documents.
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th of July 2012,
at the City of Iloilo, Philippines.

EDITHA J. AGILLES
Affiant
SUBSCRIBE AND SWORN to before me this ______________ in the City of
Iloilo, Philippines, personally appeared Editha J. Agilles, being personally known to me
and to me known to be the same person who executed the foregoing instrument. Affiant
exhibited to me her Community Tax Certificate with No. _______________ issued on
________________ at ________________________.
WITNESS MY HAND AND SEAL on the place and date first above written.

Doc. No. ________;

Page No. ________;
Book No.________;
Series of 2012.