REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR)

CITY OF BISLIG ) S.S

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, ABCDE FGHIJ KLMNO and ABCDE FGHIJ KLMNO, both of legal age, Filipinos,
and residents of Core 2, Poblacion, Bislig City, Surigao del Sur, after having sworn and in
accordance with law, hereby depose and state THAT:

1. We are the same persons described above;

2. We personally know ABCDE FGHIJ KLMNO who is the mother of ABCDE

FGHIJ KLMNO who was born on April 13, 2019 at Tagbilaran City, Bohol;

3. Due to the ignorance, her mother failed to register the fact of his birth with
the Local Civil Registrar of Tagbilaran City, Bohol and as result thereof a
negative certification was issued by the Philippine Statistic Authority;

4. We know the foregoing facts because we are closely associated with one
another, being long –time friends of the LANGI family;

5. We are not in any way related to any of the foregoing persons within the
fourth civil degree either by consanguinity or affinity, nor do we have any
pecuniary interest in this matter whatsoever.

6. We are executing this affidavit in order to attest to the foregoing facts to

support the late registration of the birth of ABCDE FGHIJ KLMNO with the
Office of the City Civil Registrar of Tagbilaran City, Bohol, and for whatever
purpose this may serve.

IN WITNESS WHEREOF, we have here unto set our hands this 5th day of May
2021 at Bislig City, Province of Surigao del Sur.

ABCDE FGHIJ KLMNO ABCDE FGHIJ KLMNO

Affiant Affiant
CRN: 0011-231434605-5 CRN: 0111-90212200-5
Issued by SSS Issued by SSS

SUBSCRIBED AND SWORN to before me on the date and place first above
written.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2023.