Republic of the Philippines )

Province of Bohol )
Municipality of Carmen ) S.S.

SELF-AFFIDAVIT
(re: Late Registration of Birth)

I, CARMELITA GUHAYON REMOROSA, Filipino, of legal age, single and a

resident of Sitio Eskwelahan I, Matin-ao, Carmen, Bohol, after being sworn in accordance with
law, hereby depose and say:

1. That I was born on October 11, 1962 at Mahayahay Dumingag, Zamboanga Del Sur, my
parents being Mamerto B. Remorosa and Roberta M. Guhayon;

2. That upon checking the records of the Philippine Statistics Authority, I found out that my
birth record is not found in their office;

3. That I was on the belief that the registration of my birth was already processed at our
Local Civil Registrar (LCR) in Mahayahay Dumingag, Zamboanga Del Sur, Philippines;

4. That I was surprised to find out that the record of my birth is not existing in the records of
our LCR;

5. That I am executing this affidavit to support the application for the late registration of
my birth at the LCR, Mahayahay Dumingag, Zamboanga Del Sur, Philippines;

6. That I further attest to the truth of the foregoing statements for whatever other legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of June, 2023 at
Carmen, Bohol, Philippines.

CARMELITA GUHAYON REMOROSA

Affiant
National ID No. 4574-3985-4034-2015
Issued by the Philippine Statistics Authority (PSA)

SUBSCRIBED AND SWORN TO before me this 14th day of June, 2023 at Carmen,
Bohol, Philippines.