REPUBLIC OF THE 

PHILIPPINES)
PROVINCE OF CEBU) S.S.
MUNICIPALITY OF PINAMUNGAJAN)
  

AFFIDAVIT OF DELAYED 
REGISTRATION OF BIRTH

         I, ________________,, of legal age, Filipino, married and a resident

of ________________, after having been duly sworn to in accordance with
law, depose and state:

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

2. That I was born in ________________, on ________________,;

3. That I was delayed in registering my birth for the reason that my parents failed
to register my birth as we transferred in another municipality when I was born.

4. That it was only recently, when I applied for NSO authenticated birth certificate,
that I found out that my birth was not registered.

4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and and in compliance with the requirements of the Philippines
Civil Registrar.

         IN WITNESS WHEREOF, I have hereunto set my hand

this ________________, in the ________________,          

________________,
Affiant

    SUBCRIBED AND SWORN TO  before me this ________________, in the

________________, affiant exhibiting to me her I.D with
number___________________________ issued in _____________________________
and valid until ______________________________.

Doc. No. _____;

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