Republic of the Philippines )

Province of __________ ) S. S.
Municipality of _________ )
x--------------------------------x


AFFIDAVIT OF DISCREPANCY

We, _____________________________ and _______________________________,
both of legal age, Filipinos, and residents of ________________________________ after having
been duly sworn to in accordance with law, hereby depose and say:

1. That we are the same persons executing this affidavit;

2. That we personally know ___________________________, a human rights
victim during the Martial Law period, who is currently processing his/her
application before the HUMAN RIGHTS VICTIMS CLAIMS BOARD
(HRVCB);

3. That to immediately facilitate the above cited process he lawfully complied with
the requirements needed including the submission of proof/documents to establish
his/her true and lawful identity;

4. That upon presentation of the same, the concerned office (HRVCB) noticed
discrepancy/discrepancies in his/her ( ) name ( ) birthdate that appears in
his/her ( ) NSO issued birth certificate/local civil registry issued birth
certificate/baptismal document/marriage certificate ( ) identification card/s
which bear the names _________________________________ and
__________________________________/ birthdates ____________________
and _______________________;

5. That the person/s named __________________________________ and
__________________________________ who was/were born on
________________________ and ______________________________ in
________________________________________ are one and the same person;

6. That we are knowledgeable of the facts and circumstances of his identity because
he has been our long time ( ) companion ( ) friend ( ) town mate ( ) co-
detainee or ( ) ____________________;

7. That we are executing this affidavit to attest to the truthfulness of the foregoing
facts for whatever lawful purpose that it may serve.


IN WITNESS WHEREOF, we have hereunto set our hands this ___ day of ______,
2014 in Ilagan City, Isabela.




Affiant Affiant


SUBSCRIBED AND SWORN to before me this ____ day of _________, 2014 in Ilagan
City, Isabela.


Doc. No. ________
Page No. ________
Book No. ________
Series of 2014.