Republic of the Philippines)

City of Butuan ) S.S.

X-----------------------------------/

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, NANITTE P. VILLA, of legal age, Filipino, single, and a resident of P- Almasiga
Barangay Pangabugan, Butuan City, and MALCOLM REY A. EGMILAN, of legal age, Filipino,
married, and a resident of P-6 Barangay Baan Riverside, Butuan City, under oath, hereby depose and state
that:
1. We personally know KISSMITH SYDNEY LABOR RAÑERA and VINCE ANGELO
BANGUIS, biological parents of the child named ISAIAH SYDRIK RAÑERA BANGUIS,
who was born on August 15, 2019 at Manuel J. Santos Hospital, Butuan City;
2. The child’s parents were not married, but the father acknowledged the child, ISAIAH SYDRIK
RAÑERA BANGUIS;
3. The child’s birth was attended by GERALDINE P. MALBAS, M.D., a Physician at Butuan
City;
4. The child’s birth was not registered within 30 days from the time of the child’s birth due to
neglect of parents;
5. The child was not baptized but was immunized;
6. We are executing this affidavit to attest to the veracity of the foregoing and to support the
application for Late Registration of Birth of the child, ISAIAH SYDRIK RAÑERA BANGUIS.

IN WITNESS WHEREOF, we have hereunto affixed our signature this 16 th day of September
2019 at Butuan City, Philippines.

NANITTE P. VILLA MALCOLM REY A. EGMILAN

Affiant Affiant
Philhealth ID No.: 18-050132447-5 Pag-ibig Id No.: 1211-4174-2423

SUBSCRIBED AND SWORN TO BEFORE ME this 12th day of September 2019 at Butuan
City, Philippines.

Doc. No. ________;

Page No. ________;
Book No. _________;
Series of 2019