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Saturday, October 17, 2009



I, JUAN DELA CRUZ, of legal age, married, Filipino and a resident of _____________, Philippines having been duly sworn in accordance with law, hereby depose and state:

That on _____________, I was issued a Philippine Passport with passport number _____________ in which my true surname DELA CRUZ was stated;

That before the expiration of the aforementioned passport on _____________, I had applied with Philippine Embassy in _____________ for the issuance of a new passport and on _____________, I was issued a new Philippine passport with passport no. _____________;

However, in the said new passport my surname had been erroneously misspelled as DELA CRUX;

That I execute this Affidavit of Discrepancy to attest to the truth of the foregoing facts and to explain the discrepancy in my Philippine Passport with regards my surname.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at _____________, Philippines.



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