REPUBLIC OF THE PHILIPPINES)

City of Baguio) S.S

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AFFIDAVIT OF DISCREPANCY ON MIDDLE NAME

I, Cerafica L. de Vera, Filipino, of legal age, single, and a resident of

#122 Lopez Jaena St., Aurora Hill, Baguio City, after having been
duly sworn in accordance with law, hereby depose and state:

1. That on April 1, 2013, I was issued a Professional

Identification Card for Medical Technologist with I.D. number
55777 in which my true Middle Name Lumabas was stated;

2. That before the expiration of the aforementioned

Identification Card on April 9, 2016, I had applied with the
Professional Regulation Commission in Baguio City for the
issuance of a new Professional Identification Card on April 4,
2016;

4. I was issued a new Professional Identification Card with I.D

no. 55777 with an expiry date on April 9, 2019

5. However, in the said new Professional Identification Card my

Middle Name had been erroneously spelled as Lamabas;

4. That I execute this Affidavit of Discrepancy to attest to the

truth of the foregoing facts and to explain the discrepancy in my
Professional Identification Card with regards my Middle Name.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th of

January 2017, at the Marquez Law Office, 304 Porta Vaga Bldg.,
Baguio City, Philippines.

Cerafica L. De Vera
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and

for the City of Baguio this 17th of January 2017. Affiant personally
came and appeared with her non-professional drivers license with
license number N25-12-004694 issued by the Department of
Transportation and Communication, Land Transportation Office on

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April 2, 2016 at the Land Transportation Office in Agoo, bearing her
photograph and signature, known to me as the same person who
personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said
instrument.

Doc. No. 7
Page No. 14
Book No. 1
Series of 2017

Atty. Princess Karina M. Marquez, RMT

Notary Public
Commission Serial No. 123456789
Until December 31, 2017
PTR No. 3202017; January 8, 2017; Baguio City
Roll No. 55701
IBP Lifetime Roll No. 987654321;Baguio City
MCLE Compliance Cert. No. 654987321
304 Porta Vaga Bldg., Baguio City

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