Republic of the Philippines

Province of Samar

JOINT AFFIDAVIT for DELAYED REGISTRATION of BIRTH CERTIFICATE

We, GINA FRANCISCO and EDWIN NUEVA Both of legal age, Filipino and
residents of Rawis Gandara, Samar, after having been duly sworn to in accordance with law,
hereby depose and say;

That we personally know the spouses MYLENE B. BARILLO and JULIO D.

ALIMAN both of legal age, Filipino and residents of Barangay Rawis, Gandara, Samar.

That during their union, they begot several children namely;

NAME DATE OF BIRTH

1. JAMES BARILLO ALIMAN APRIL 08, 2018

all from Gandara, Samar, Philippines and was/were later baptized in accordance with the rites of
the Roman Catholic.

Due to the negligence of the aforesaid couple concerning civil registration, said birth of
the aforenamed child/children were not reported at the concerned Office of the Civil Registrar.

That we both know all these facts because we have been their close acquaintance for
quite a long time;

That we are not in any way related with aforementioned persons either by affinity or
consanguinity;

That we are executing this affidavit to attest to the truth of all the foregoing facts and
further for whatever purpose or legal intent it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this __________ day of
___________________ ________at Catbalogan, Samar.

GINA FRANCISCO EDWIN NUEVA

Affiant Affiant

Comm. Tax Cert. No. _______ Comm. Tax Cert. No. _______
Issued on: _______ Issued on: _______
Issued at: _______ Issued at: _______

SUBSCRIBED and SWORN to before me this ________ day of ____________________

Catbalogan City, Samar, Philippines.