Affidavit of Discrepancy - Suffix Placement (Dimasacat JR.)

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REPUBLIC OF THE PHILIPPINES)

SILANG, CAVITE ) S.S.

AFFIDAVIT OF DISCREPANCY

I, GIE-ANN TAGHAP CLOMA, of legal age, Filipino Citizen, single and a resident of
Sitio Ilaya, Kaong, Silang, Cavite, after having been duly sworn in accordance with law,
hereby deposes and says:

1. That I have applied as “FACTORY WORKER” at JS CONTRACTOR INCORPORATED


bound to TAIWAN last June 27, 2022;

2. As such, they have requested me to submit my original documents along with the
photocopies of the following documents:

a. Certificate of live birth (PSA)


b. Philippine Passport
c. UMID/SSS I.D.
d. College Diploma / TOR
e. Voter’s ID or Voter’s Certificate
f. TIN/BIR I.D.
g. NBI Clearance etc.

3. That, on my documents such as Certificate of Live Birth, Philippine Passport,


UMID ID, College TOR and Voter’s Certificate, my first name was duly recorded
as “GIE-ANN”; thus, my full name appeared as
“GIE-ANN TAGHAP CLOMA”;

4. However, as per my TIN/BIR I.D. and NBI Clearance, my first name was duly
recorded as “GIE ANN”; thus, my full name appeared as “GIE ANN TAGHAP
CLOMA”;

5. That I am attesting to the fact that my true and correct name is “GIE-ANN” and
NOT “GIE ANN” which I have been using in all of my private and public
documents;

6. That I am executing this affidavit for the purposes of correction of the same to
avoid further confusion;

7. That I am executing this affidavit to attest to the truth of the foregoing


instrument and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this June 30, 2022 in Silang,
Cavite.

GIE-ANN TAGHAP CLOMA


Affiant
Passport No. P1657519B

SUBSCRIBED AND SWORN to before me this June 30, 2022 in Silang, Cavite.
Affiant exhibited to me her Philippine Passport.

Doc. No. _____ ATTY. ZALDY M. AMBON


Page No. _____ Notary Public
Book No. _____ Commission No. NP217-20
Series of 2022. Until June 30,2022
Roll No. 68528 / 05-29-17
IBP LFM No. 016450, Pasig City
PTR No. 5502781 / 01-03-22, TMC, Cavite
MCLE Compliance No. VII-0018191
Valid Until April 14, 2025
128 Karsadahan, Kanluran, Brgy. Kaong
Silang, Cavite 4118

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