Republic of the Philippines)

Province of Samar) S.S.

Municipality of Hinabangan)

AFFIDAVIT
(Re: Late/Delayed Registration of Birth)

I, Jia Estrella, 30 years of age, respectively, Filipino citizen and with residence
and postal address at POblacion II Hinabangan, Samare, after having been duly sworn
and oath in accordance with law hereby voluntarily depose and say:

1. That was born on 25th of December 2014 at Daniel O. Mercado Medical Center,
Tanauan City, Batangas, Batangas to the Spouses RAFAEL SALAZAR ESTEBAN and
JANICE ROJAS RAPOSAS;

2. That due to the negligence and/or inadvertence on the part of my parents and
the prevailing conditions then, his birth was not reported and registered with the Office
of the Municipal Civil Registrar of Talisay, Batangas immediately thereafter;

3. That we have first hand knowledge of the foregoing facts because we together
with our respective families, being their acquaintances and close family friends, were
among those who first visited her and her mother on the day that she was born as is
customary in the province;

4. That we are executing this Joint affidavit to attest to the truth of all the foregoing
facts, in connection with the application for the late/delayed registration of birth of the
said RAF JAN RAPOSAS ESTEBAN with the office of the Municipal Civil Registrar of
Talisay, Batangas and for whatever legal purpose this may serve;

IN TRUTH WHEREOF, we have hereunto set our hands, this __________________ at

Tanauan City, Batangas, Philippines.

CAMILO C. ROXAS LUZVIMINDA T. ROXAS

Affiant Affiant

SUBSCRIBED AND SWORN to before me, this _____________________ at Tanauan

City, Batangas, Philippines, affiants exhibiting to me their respective Community Tax
Certs. Nos. _________ and __________ both issued at Talisay, Batangas on
_____________, 2020.

Doc. No. _______;

Page No. _______;
Book No._______;
Series of 2020.