Statutory Declaration
Regarding Name Discrepancy
I,
of
do solemnly and sincerely declare as follows:
1. My true and correct name is
.
2. However, in certain documents, my name appears as
.
3. I declare that
(specify relationship between names) refer to the same person, which is myself.
4. The reason for the discrepancy is
.
5. I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the applicable laws.
Declared at
this
day of
, 20
Signature of Declarant
Before me,
(Name and Signature of Notary Public/Commissioner for Oaths)