LATE REGISTRATION OF LIVE BIRTH

I, BELEN TAYABAS OMOSORA, Filipino, of legal age, and presently

residing at Block 23, Lot 9, Phase 3, Argon Street, Emily Homes,
Cabantian, Davao City, after having been duly sworn to in accordance
with law, hereby depose and state that:

1. I am the mother of KEIKO OMOSORA MATSUOKA who was born

on January 4, 2009 at Davao del Sur, Philippines;

2. I did not register the birth of the said child due to delayed
information of data of birth;

3. That I am executing this affidavit for the purpose of our visa

application for Japan.

AFFIANT SAYETH FURTHER NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th

day of March 10, 2018 in Davao City, Philippines.

BELEN TAYABAS OMOSORA

AFFIANT

SUBSCRIBED AND SWORN before me this 10th day of March

2018, who exhibited to me her Passport with Passport number
EC7846376 issued on May 28, 2016 at Davao City.

Notary Public

Doc. No. _____:

Page No. _____;
Book No. _____
Series of 2018.