Republic of the Philippines )

Province of Occidental Mindoro) S.S.

Municipality of Mamburao)

AFFIDAVIT FOR OUT OF TOWN LATE REGISTRATION OF BIRTH

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

Poblacion 2, Sta. Cruz, Occidental Mindoro, after having been duly sworn to in
accordance with law, hereby depose and say that:

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

2. I was born on ____________________ in __________________________, to spouses
________________________ and _______________________;
3. I have no knowledge on who attended my birth;
4. My birth was not registered at the Office of the Municipal Civil Registrar of
_______________________ due to my parents’ negligence;
5. This affidavit is executed to attest to the fact surrounding my birth and to support
my application for delayed registration of birth pursuant to Rule 20 of
Administrative Order No. I, series of 1993.

IN WITNESS WHEREOF, I have set my hand this 16 th day of May 2024 at

Mamburao, Occidental Mindoro.

____________________________
Affiant
(OSCA ID: 1410)

ATTESTATION

WE, _______________________ and _______________________, both of legal age,

Filipino citizens, and residents of Poblacion 2, Sta. Cruz, Occidental Mindoro
respectively, under oath, do hereby affirm and hereby confirm that the foregoing
statements are true and correct.

We, further state that we personally know the affiant and the person subject for
delayed registration of birth.

______________________ _________________________
Affiant Affiant
(OSCA ID: 0239) (OSCA ID: 0228)

SUBSCRIBED AND SWORN TO BEFORE ME this 16th day of May 2024 at

Mamburao, Occidental Mindoro, and affiants exhibited to me their valid identification
indicated below their names.

ATTY. __________________________
REPUBLIC OF THE PHILIPPINES)
MAMBURAO, OCCIDENTAL MINDORO) S.S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, _______________________, married, and ________________________,

widow, both of legal age, Filipino citizens, and residents of Poblacion 2, Sta. Cruz,
Occidental Mindoro, after having been duly sworn to in accordance with law, hereby
depose and state that:

1. We personally know _________________________ who was born on

__________________ at ______________________________;

2. We know her to be the biological child of ___________________ and

__________________________;

3. She is married to ________________________;

4. We know the fact of her date of birth on ___________________ and she being the
biological child of ______________________ because we are her close friends and
likewise neighbors who reside in _____________________________;

5. We have known each other for decades now and there are also many instances in
the past where we celebrated her birthday together;

6. Her birth was not registered due to her parents’ negligence;

7. We are not related to the said person by affinity or consanguinity;

8. We are executing this affidavit to attest to the truthfulness of the foregoing, to

support the application for late registration of birth of _______________________
and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 16 th day of May
2024 at Mamburao, Occidental Mindoro.

________________________ ________________________
Affiant Affiant
(OSCA ID: _______) (OSCA ID: ________)

SUBSCRIBED AND SWORN TO BEFORE ME, this 16th day of May 2024 at
Mamburao, Occidental Mindoro, affiants exhibiting to me their competent proofs of
identity.

ATTY. __________________________