Republic of the Philippines ]

Santa Cruz, Laguna ] s.s.

AFFIDAVIT OF DISCREPANCY

I, WILFREDO RICHARDSON GUSAY, of legal age, Filipino, and resident of Brgy.

Brgy. Mojon, Liliw, Laguna, after having been sworn in accordance with law, hereby
depose and state that –

1. I am a holder of an expired Philippine Passport. In my Certificate of Live Birth, my

name appears as WILFREDO RICHARSON GUSAY.

2. In my marriage contract and other records, my name appears as WILFREDO

RICHARDSON GUSAY.

3. I hereby certify and affirm that the names “WILFREDO RICHARSON GUSAY” and
“WILFREDO RICHARDSON GUSAY” refer to one and the same person, the
undersigned.

4. I executed this affidavit to attest to the truth of the foregoing facts and for
whatever lawful purposes this may serve.

IN WITNESS WHEREFORE, I hereto affixed my signature this 17th day of September

2016 in Santa Cruz, Laguna.

WILFREDO RICHARDSON GUSAY

Affiant

SUBSCRIBED AND SWORN to before me by the affiant with Driver’s License I.D.
No. N16-83-034917 issued on 17 September 2014 in LTO Pila, Laguna.

Doc. No. _____; A T T Y. E M M A N U E L E . S A N D I C H O

Page No._____; NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016
Book No._____; NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA
Series of 2016. PER NOTARIAL COMMISSION SP. PROC. NO. 164(15)
IBP O.R. No. 995689, 04 January 2016, Laguna Chapter
PTR O.R. No. 2967138, 04 January 2016, Laguna
Roll No. 42246, admitted to practice law on 9 May 1997
MCLE Compliance No. V-0015412, dated 6 March 2016