REPUBLIC OF THE PHILIPPINES )

BACOOR CITY )SS

AFFIDAVIT OF EXPLANATION

I, ________________, Filipino, of legal age, married, and with residence and postal address at
______________________________________________, after having been duly sworn to in accordance with law
hereby deposes and states:

1. That in my Certificate of Live Birth issued by the National Statistics Office it was indicated that I was
born on _______________________ at ________________________________;

2. That however, upon further examination of my Certificate of Live Birth, it appears that my Certificate of
Live Birth was inadvertently recorded in the Municipal Civil Registrar of ______________, Manila instead of in
_______________;

3. That my Certificate of Live Birth was erroneously recorded in the Municipal Civil Registrar of
____________, when in truth and in fact, it should have been recorded in __________________, since I was
actually and really born in _____________________;

4. That I executed the foregoing affidavit to attest to the truth of the facts herein stated and for the
correction and/or transfer of the registration of my Certificate of Live Birth in the
_____________________________and for any legal/lawful purpose;

AFFIANT SAYETH NAUGHT.

___________________
AFFIANT

SUBSCRIBED AND SWORN to before me this _______________________ in Bacoor CIty, affiant

exhibiting to me her __________________________________ as competent proof of her identity.

Doc. No. _____ ___________________________

Page No. _____ NOTARY PUBLIC
Book No. _____
Series of 2022.