REPUBLIC OF THE PHILIPPINES)

Davao City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, BELEN TAYABAS OMOSORA , of legal age, single, Filipino and a resident of Blk 83,
Lot 9, Phase 3, Argon st., Emily Homes, Cabantian, Davao City, Philippines, under oath state:

1. THAT my full and correct name is BELEN TAYABAS OMOSORA;

2. THAT the first name appearing on my Certificate of Live Birth registered with
the Civil Registry Davao City and with the National Statistics Office is not clear
as it can be read by at instant as “BEEEN” or “BELEN”. A copy of my
certificate of Live Birth issued by the Civil Registry of Davao and the National
Statistics Office are hereto attached as ANNEXES “A” and “B”, respectively;

2. THAT there seems to be an error in the entry my first name “BELEN” in those
documents;

3. THAT the first name BELEN and “BEEEN” refer to one and the same person, the herein
Affiant;

4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use
the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 22nd day of January 2012 at Davao
City.

REINIER DECIERDO
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of January 2012 at Davao City, Affiant
exhibiting to me his TIN # 259-159-192-000 issued at Davao City on January 31, 2008.

Atty. Forcrissa Gogo

Notary Public until December 2012
Roll No. 9195
Doc No. _________ IBP No. 92175/12.21.11/Davao City
Page No. ________ PTR No. 87541/12.21.11/Davao City
Book No. ________ TIN- 245-187-254/10.4.11/Davao City
Series of 2012 MCLE No. III-0002451/10.12.11