REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAMARINES NORTE )S.S

MUNICIPALITY OF LABO )

AFFIDAVIT FOR DELAYED REGISTRATION

We, _______________________, of legal age, Filipino citizens, and residents of

________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That we personally know spouses _________________ who are residents of

__________________________;
2. That we also know that the aforesaid spouses have begotten a child who was named
________________________, born on April 24, 1932 in
____________________________
3. That we likewise came to know that it was a hilot/midwife who attended the mother
when the said child was born;
4. That we are executing this affidavit in good faith to prove the birth and identity of the
said child in support to the application for inclusion of her birth records in the
Registry Book of Live Births as late registrants at the Municipal Civil Registry Office
of ______________________ and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 14 th day of July 2014 at
________________________, Philippines.

Doc. No._____________ NOTARY PUBLIC

Page No._____________
Book No.____________
Series of 2014.