Republic of the Philippines )

_____________________ ) S.S.
x-----------------------x

AFFIDAVIT OF ATTENDANT AT BIRTH

I,Dr. ____________________________ , Filipino, of legal age, (single /
married /widow), and a resident of _________________________________________
_______,Philippines, having been duly sworn in accordance with law, hereby depose
and state:

That I am a duly-license medical doctor, practicing at __________________

__ (Hospital/Clinic) with Professional License No. ___________________ issued on _
___________________ at ______________________;

That on or about ______________(time) of ________________(date),

Ipersonally attended to a patient named __________________________________
ingiving birth by (normal delivery/caesarian section) to a baby (boy/girl) whom they
namedas ______________________________;

That I execute this Affidavit to attest to the truth of the foregoing facts
and for anyother legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set our hands this ______________

_in __________________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me, this _________________, by the

Affiant whom I have identified through competent evidence of identity and who
exhibitedhis/her _______________________________.Doc. No. ______;Page No. ____
__;Book No.______;Series of 20___.