REPUBLIC OF THE PHILIPPINES )

____________________________ ) S.S.
x-----------------------------------x
AFFIDAVIT OF LATE REGISTRATION
I, ___________________, of legal age, Filipino, married and a resident of
____________________________, after having been duly sworn to in accordance with
law, do hereby depose and say, that:

1. I am the same and identical person who caused the execution of this affidavit;

2. I was born on ____________ with parents ____________ and

______________ at _____________ with the name
______________________;

3. My birth was not reported to nor recorded with the Office of the Local Civil
Registrar of _________________ because my parents were not aware of said
registration of Live Birth at the time I was born;

4. I am executing this affidavit to attest to the truth of all the foregoing facts and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ______
at ________________.

______________________
Affiant

CORROBORATION STATEMENT

____________ and _________________, are both Filipino citizens, of legal

ages and residents of Brgy. Kaligutan, Laak, Compostela Valley, do hereby depose and
state, that:

1. We have personal knowledge of the birth of the above-stated child on the date
and place above-stated and hereby confirm of the truth of the above facts;

2. We are executing this statement to attest to the truth of all the foregoing facts
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ____ day of _______
at ________________.

_________________ __________________

SUBSCRIBED AND SWORN to before me this ____ day of _______ at

________________.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2019.