Republic of the Philippines)

Province of Sorsogon ) S.S

Sorsogon City )

AFFIDAVIT

I, MARIA APOLONIA GIBAGA JEBULAN, Filipino, legal age, married

and a resident of Brgy. Cogon, Juban, Sorsogon, Philippines after having
been sworn to in accordance with the law hereby depose and say:

1. That on August 3, 2017 around 3:00 o’clock in the morning, I

assisted Shirley Arevalo Gibaga who was then about to deliver her
baby;

2. That we decided to brought her in Provincial Hospital, Sorsogon

utilizing a tricycle;

3. That upon reaching Sorsogon City within the vicinity of Brgy. Balogo
in front of Sts. Peter and Paul Hospital, the patient delivered her
baby girl in the tricycle;

4. That as a matter of fact Dra. Chacon of Sts. Peter and Paul was the
one who removed the placenta and cut the umbilical cord;

5. That upon application for registration of birth of the baby at Sts.

Peter and Paul, Dra. Chacon refused to sign for according to her she
didn’t actually perform the full procedure in delivering the infant;

6. That I am executing this affidavit to attest to the truth of the

foregoing facts and circumstances and to support the application for
registration of Birth of the infant;

IN WITNESS WHEREOF, I have hereunto set my hand this

____________________ at Sorsogon City, Philippines.

MARIA APOLONIA GIBAGA JEBULAN

Affiant
DL-E05-16-003721

SUBSCRIBED AND SWORN to before me on the date and place first above-
written.

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