REPUBLIC OF THE PHILIPPINES )

MUNTINLUPA CITY ) S.S.

JOINT AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

We, and ., both of legal age, Filipinos and with resident and postal
address at,Batangas, after being sworn in accordance with law, depose and
state that:

1. We are the parents of (“MISHIA”) who was born at, Batangas;

2. The reason for the delayed registration of her birth is due to our
inadvertence; and

3. We are executing this Affidavit to attest to the truth of the foregoing

stipulations for purposes of recording and registering the facts of
birth of MISHIA with the LCR of Malvar, Batangas and the Philippine
Statistics Office and for whatever legal purpose this may serve best.

Affiant Affiant

SUBSCRIBED AND SWORN TO before me this in City, affiants are

personally known to me.