REPUBLIC OF THE PHILIPPINES)

PROVINCE OF OCCIDENTAL MINDORO) S.S.

MUNICIPALITY OF SABLAYAN)

AFFIDAVIT OF DELAYED
REGISTRATION OF BIRTH

I, MERABEL FAVILONIA CAMONINO, of legal age, Filipino, married and

a resident of Barangay San Vicente, Occidental Mindoro after having been duly
sworn to in accordance with law, depose and state:

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

2. That I was born in Sta. Cruz, Occidental Mindoro on July 25, 1992;

3. That I was delayed in registering my birth for the reason that my parents failed
to register my birth as we transferred in another municipality when I was born.

4. That it was only recently, when I applied for NSO authenticated birth certificate,
that I found out that my birth was not registered.

4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and and in compliance with the requirements of the Philippines
Civil Registrar.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day

of January, 2018 in the Municipality of Sablayan, Province of Occidental
Mindoro.

MERABEL FAVILONIA CAMONINO

Affiant

SUBCRIBED AND SWORN TO before me this 19th day of January

2018 in the Municipality of Sablayan, Province of Occidental Mindoro affiant
exhibiting to me her I.D./CTC with number___________________________ issued
in _____________________________ and valid until ______________________________.

Doc. No. _____;

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