REPUBLIC OF THE PHILIPPINES )

CAPAS, TARALC..) S.S.

AFFIDAVIT OF DELAYED REGISTRATION

OF BIRTH OF AN ILLEGITIMATE CHILD
I, FRANCIS D. PEREZ, of legal age, Filipino, single, Filipino and a
resident of Dona Lutgarda Subdivision, Barangay Cutcut 1st, Capas, Tarlac, after
having been duly sworn to in accordance with law, depose and state:
1. That, I am the applicant for the delayed registration of birth of my
son NICOLE CONSTANTINO PEREZ;
2. That, NICOLE CONSTANTINO PEREZ was born on April 19, 2011 in
Capas, Tarlac to her parents FRANCIS D. PEREZ and MARITES P.
CONSTANTINO;
3. That, I and MARITES P. CONSTANTINO are not married thus,
NICOLE CONSTANTINO PEREZ is our illegitimate daughter;
4. That, NICOLE CONSTANTINO PEREZ was attended by a midwife who
also resident in Capas, Tarlac:
5. That NICOLE CONSTANTINO PEREZ, is a Filipino citizen having born
to Filipino parents:
6. That the birth of NICOLE CONSTANTINO PEREZ was not duly
registered with the Office of the Civil Register of Capas, Tarlac due to
inadvertence of the midwife that attended on her birth;
7. That, I am executing this affidavit to attest to the truth and veracity of the
foregoing facts and in compliance with the requirements of the Philippine Civil
Registrar.
IN WITNESS WHEREOF, I have hereunto set my hand this 10th day
of October, 2016, in Capas, Tarlac, Philippines.
FRANCIS D. PEREZ
Affiant
th
Subscribed and sworn to before me this 10 day of October 2016, in Capas,
Tarlac, affiant exhibited to me his SSS Identification Card, with ID No. 01112840020-6, for affiants personal identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2016.