REPUBLIC OF THE PHILIPPINES ]

Province of Bohol ]
Municipality of Carmen ] S.S.

SELF-AFFIDAVIT

I, ANELYN SAGA SARNADA, of legal age, Filipino, single and a resident of Nueva
Vida Este, Carmen, Bohol, Philippines, after having been duly sworn in accordance with law, do
hereby depose and state:

1. That I am the mother of KHARA JANE SERNADA PAJO who was born on May 17,
2021 at Imap-Lying-In Clinic Inc. Tambo-an, Carmen, Bohol;

2. That I was not able to immediately register my daughter’s birth as his father was still
on board, being a seaferrer, at the time and date of her birth;

3. That the absence of the father KHARA JANE SERNADA PAJO caused the delay of
her birth registration at the Local Civil Registry of Carmen, Bohol since the father’s
signature is required;

4. That I am executing this affidavit to support the late registration of the birth of my
daughter, KHARA JANE SERNADA PAJO at the Local Civil Registry of Carmen,
Bohol;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of August, 2021 at
Tagbilaran City, Bohol, Philippines.

ANELYN SAGA SERNADA

Affiant

SUBSCRIBED AND SWORN TO before me this 4th day of August, 2021 at Tagbilaran
City, Bohol, Philippines.