Republic of the Philippines )

Province of __________ ) S.S

______________ )
x-----------------------------x

AFFIDAVIT OF TWO DISINTERESTED PERSONS

WE, _________ and _____________, both of legal age, Filipinos and residents
of _______________ after having been duly sworn to in accordance with law, do hereby
depose and state that;

1. We personally know ________________ and ____________ because

they are our friends and we live in the same locality since then;

2. We know for a fact that on ____________, _________ gave birth to

_______________, at __________________ whose birth up to now has not been
recorded with the Local Civil Registrar of _________________;

3. We are executing this affidavit for the purpose of registering the child’s
Certificate of Live Birth at the ____________________- and for such other legal purposes
that this affidavit may serve.

IN WITNESS WHEREOF, we have hereunto set our hands, this ___day of

February 2019 at _____________.

_____________ ______________
Affiant Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this _____day of February 2019 at

___________________.

______________________
Administering Officer