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Affidavit of Discrepancy

Ariel Dublin executed an Affidavit of Discrepancy to correct an error in his wife Corazon Gonzales Dublin's date of birth recorded in his Philhealth records. He stated he had erroneously listed her date of birth as December 6, 1966 instead of the correct date of December 6, 1964 as shown in her hospital records. Dublin attested this was an inadvertent mistake made when filling out the Philhealth documents and signed the affidavit to correct the discrepancy.

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893 views1 page

Affidavit of Discrepancy

Ariel Dublin executed an Affidavit of Discrepancy to correct an error in his wife Corazon Gonzales Dublin's date of birth recorded in his Philhealth records. He stated he had erroneously listed her date of birth as December 6, 1966 instead of the correct date of December 6, 1964 as shown in her hospital records. Dublin attested this was an inadvertent mistake made when filling out the Philhealth documents and signed the affidavit to correct the discrepancy.

Uploaded by

Dax Monteclar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines)

City of Cebu ) S.S


X------------------------------------/

AFFIDAVIT OF DISCREPANCY

I, ARIEL DUBLIN, of legal age, Filipino citizen, and a resident of Cebu


City, Philippines, after having been duly sworn in accordance with law, hereby
depose and state:

1. That I am a bona fide member of Philhealth;

2. That I put my wife Corazon Gonzales Dublin as my beneficiary


therein;

3. That I erroneously put her date of birth in Philhealth records as


December 6, 1966 instead of her true and correct date which is
December 6, 1964, as now correctly reflected in the hospital records;

4. That said error in Philhealth records is due to mere inadvertence on


my part in filling up the documents;

5. As such, I am executing this Affidavit of Discrepancy to attest to the


truth of the foregoing, and for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 3 rd


day of September 2021 at Cebu City, Philippines.

ARIEL DUBLIN
Affiant

SUBSCRIBED AND SWORN TO before me this 3rd day of September


2021 at Cebu City, Philippines, affiant exhibiting to me his valid ID, as competent
evidence of her identity.

Doc. No. 207 ;


Page No. 78 ;
Book No. I ;
Series of 2021 .

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