AFFIDAVIT FOR DELAYED REGISTRATION

OF BIRTH

I, ELSA DONGQUE UGSOD SALVA, of legal age, married and with

residence address at Mauswagon, Laguindingan, Misamis Oriental, after
having duly sworn to in accordance with law, do hereby depose and say:

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

2. That I was born on December 21, 1954 at Mauswagon, Laguindingan

(formerly part of Alubijid at the time of birth), Misamis Oriental;

3. That I believe all the time that my birth had already been registered by
my parents with the National Statistics Office (now Philippine Statistics
Authority). However when I tried to secure a copy of my Certificate of Live
Birth with Philippine Statistics Authority, it was found out that nothing
in their records appears to be my name or birth;

4. That I execute this affidavit to attest the truth and veracity of the
foregoing statements and for the purpose of applying for the delayed
registration of my birth.

IN WITNESS WHEREOF, we have hereunto set our hands this 11th day
of December, 2018 in the City of Cagayan de Oro.

ELSA DONGQUE UGSOD SALVA

Affiant

SUBSCRIBED AND SWORN TO before me this 11th day of December,

2018 at Cagayan de Oro City.

Doc. No. _184___;

Page No. __37___;
Book No. __II___;
Series of 2018