Republic of the Philippines )

Puerto Princesa City ) S.S

AFFIDAVIT OF DELAYED REGISTRATION OF BIRTH

I, GRACE M. DALINGDING, of legal age, Filipino, single and a resident of Purok

Masagana, Manamoc, Cuyo, Palawan, after having been duly sworn to in accordance with
law, depose and state:

1. That I am the biological mother of KIMBERLY D. FAVILA born on September 27,

2009 at Cuyo, Palawan and JUSTINE D. FAVILA, born on July 5, 2013 at Cuyo,
Palawan;

2. That the said birth KIMBERLY D. FAVILA and JUSTINE D. FAVILA was not
registered and/or recorded at the Local Civil Registrar of the Municipality of Cuyo,
by reason that after I give birth to my daughter I, transferred here at Puerto Princesa
City to attend the medical condition of my mother;

3. That I will submit this Affidavit of Late Registration to the Office of the Civil
Registrar of Puerto Princesa City, Palawan, the soonest to comply with requirements
to process the registration of birth KIMBERLY D. FAVILA and JUSTINE D. FAVILA;

4. That I executed this affidavit to attest to the truthfulness of the

foregoing instrument purposely for the registration of the birth
KIMBERLY D. FAVILA and JUSTINE D. FAVILLA at the Civil Registrars Office
of Puerto Princesa City, and for whatever legal purpose the same may
serve.

IN WITNESS WHEREOF, I have hereunto set our hands, this June 9, 2017 at Puerto
Princesa City

GRACE M. DALINGDING/Affiant
VIN:5310-0027A-E2489GMD20000

SUBSCRIBED AND SWORN to before me, this June 9, 2017 at Puerto Princesa City,
affiant exhibited to me her competent evidence of identity as indicated under her name and
signature.

Doc. No. _______;

Page No. _______;
Book No. ______;
Series of 2017.