Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of San Miguel )

AFFIDAVIT OF TWO DISINTERESTED PERSONS

(Late Registration of Birth)

We, MARIA GRACE D. BALAIS and RUBEN A. LABARDA

(full name of affiant 1) (full name of affiant 2)

Filipinos,both of legal age, and residents of San Miguel, Leyte respectively,

(municipality & province; address)

after having been duly sworn to in accordance with law, hereby declare THAT:

1. We both personally know ALICE C. LABITAG

(mother of child)
UNKNOWN;
(father of child)

2. They gave birth to KEVIN C. LABITAG and he/she was born

(full name of child/person to be late registered)

on May 11, 2000 at Leyte Provincial Hospital

(date of birth of child) (place of birth of child)

3. Said fact of birth was not duly registered at the Office of the Local Civil

Registrar of San Miguel, Leyte due to excusable negligence on the part of

the (municipality & province ),

parents;

4. We are not related in any way to the above-named person/s either by

consanguinity or affinity. Hence, we are disinterested persons;

5. We are executing this affidavit to attest to the truth of the foregoing statements to
support the late registration of birth of said person and for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this January 18, 2018 at San

Miguel, Leyte, Philippines.

MARIA GRACE D. BALAIS RUBEN A. LABARDA

Affiant (name of affiant 1 & signature above it) Affiant (name of affiant 2 & signature above it)

ID Presented: ID Presented:
SOLO PARENTS ID EMPLOYEE ID
ID NUMBER: 0006 ID NUMBER: 015-15

SUBSCRIBED AND SWORN TO before me this January 18, 2018 at San Miguel,

Leyte, Philippines.