REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

AFFIDAVIT FOR OUT OF TOWN

DELAYED REGISTRATION OF BIRTH

I, ANGELITO KULELAT of legal age, married and with residence and postal address at No.
123456-G Sgt. Yabut Street, Guadalupe Nuevo, Makati City after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am the applicant for the delayed registration of my birth;

2. I was born on 22 September 1963 at Cotabato City from parents CARLITO KULELAT and FE
KULELAT;

3. I was attended at birth by PATROCINIO RIZAL M.D. at COTABATO GENERAL HOSPITAL;

4. I am a FILIPINO citizen;

5. My parents were married on 8 December 1962 at Manila City;

6. The reason for the delay in registering my birth was due to the Muslim Insurrection at
Mindanao and my family was forced to evacuate from Cotabato City;

7. A copy of my birth certificate is needed for the purpose of foreign travel;

8. I am married to EMELYN NALATE on 8 December 1998 at THE MUNICPAL TRIAL COURT of

Acop, Tublay, Benguet;

9. I am executing this affidavit to cause for the late registration of my birth to the Civil of
Registrar of MAKATI CITY.

FURTHER AFFIANT SAYETH NAUGHT.

____________________________
ANGELITO KULELAT
Affiant
CTC No.: 0012345678
Issued on: 07/17/2008
Issued at: Makati City

ATTESTED BY:

_______________________ _______________________________
NORMANDY NOTIME ADOLF ROOSEVELT
CTC No.: CTC No.: 23456789
Issued On: Issued On: 01/04/2008
Issued At: Quezon City Issued At: Quezon City

SUBSCRIBED AND SWORN to before me this ______day of ___________,2008 at Makati City,

Philippines.

NOTARY PUBLIC

Doc. No. _______

Page No. _______
Book No. _______
Series of 2008