Republic of the Philippines)

City of Butuan ) S.S.

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

AFFIDAVIT OF APPLICANT

I, HERMINIA BIOL CASAÑA, of legal age, Filipino, single, and a resident of P-9
Barangay Maug, Butuan City, after having been duly sworn to in accordance with law, do hereby
depose and state:
1. That I was born on September 05, 1945 at Barangay Mahay, Butuan City to the spouses
VICTORINA ABAN BIOL and EUGENIO CASAÑA;
2. That I am an applicant of late registration
3. That my birth was not registered at the Local Civil Registrar’s Office, Butuan City,
because the person who was delegated the same failed to do so due to negligence and
financial constraints;
4. That my parents were legally and validly married, but due to the lapse of time, I have
forgotten the exact date and place of their marriage;
5. That the name and whereabouts of the attendant at birth are unknown due to lapse of
time;
6. That I am executing this affidavit to attest to the veracity of the foregoing and to support
my application for Late Registration of Birth at the Office of the City Civil Registrar.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 5 th day of March

2018 at Butuan City, Philippines.

HERMINIA BIOL CASAÑA

Affiant
OSCA: 33036

SUBSCRIBED AND SWORN TO BEFORE ME this 5th day of March 2018 at Butuan
City, Philippines.

Doc. No. ________;

Page No. ________;
Book No. _________;
Series of 2018