Republic of the Philippines)

Province of Cebu) S.S

City of Mandaue )

AFFIDAVIT OF EXPLANATION

I, _______________________, of legal age, Filipino citizen, married and resident of

Kawit, Medellin, Cebu, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and say that:

1. That I am the mother of ______________________ who was born on April 26, 2000 in
Queen Elizabeth Hospital Kota, Kinabalu, Kerajaan, Malaysia;

2. That as per record entry in my son’s Birth Certificate issued by the Kerajaan,
Malaysia, the name of the mother erroneously recorded as _____________________,
instead of ______________;

3. That the name of mother ________________ and ___________________, refers to one

and the same person;

4. That the above-mentioned discrepancy was caused perhaps through inadvertence in

which the country that my son was born had their own regulations/system in
regards of registering of the birth of the child which commemorate in my own
records/birth certificate which I, as the mother and also born in the same country
“Malaysia” they intend to indicate the name of mother first name which is
“NANCY” and the first name of my biological father as “ANTONIO” that appeared
in my son’s Birth Certificate, the name of mother herein indicated as “NANCY
ANTONIO”;

5. That I acknowledge that I have caused the preparation and understood this
instrument, read the same and confirm that I have executed willingly, voluntarily
and with full knowledge thereof;

6. That I hereby undertake, attest freely, confirm, promise under oath that the
abovementioned statement is base on facts true and correct thereon;

7. That I am executing this affidavit to attest to the truth of the foregoing facts and
statement in compliance with the requirements for the Delayed Registration of Birth
Certificate of my son ____________________ at Department of Foreign Affairs (DFA)
and for all legal intents and purposes this will serve best.

IN WITNESS WHEREOF, I have signed this Affidavit on this _____________ in the City
of Mandaue, Province of Cebu, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN TO BEFORE ME this _________________in the City of

Mandaue, Cebu, Philippines. Affiant exhibited to me his competent proof of identity described
above.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2022.