REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU … … … … … … ...)Ss.

AFFIDAVIT OF
TWO DISINTERESTED PERSONS
(For Delayed Registration of Birth)

WE, _________________________ and _________________________, both Filipino

citizens, of legal age, single, and respectively residing in Brgy. Cogon Pardo, Cebu
City and Brgy. Inayawan, Cebu City; having been sworn in accordance with the law,
hereby depose and state:

1. THAT we personally know ________________________, born last December 1,

2012, Cebu Puericulture Center and Maternity House, Inc., Cebu City, Cebu, to
spouses: ____________________ and ____________________, residents of Cebu City,
Philippines;

2. THAT we know that the minor was attended at birth by _____________________,

resident of Cebu City, and that her parents are not married but she was
acknowledged by his father, ______________________;

3. THAT we further know, however, that _____________________ facts of birth have

not been registered with the Local Civil Register, Cebu City and the National
Statistics Office;

4. THAT the reason for the delayed registration of the facts of birth of
____________________was because of ____________________ decision (mother) to
wait for the arrival of the child’s father from abroad to sign the affidavit of
paternity beyond the reglementary period;

5. THAT we are not related to ____________________either by consanguinity or

affinity;

6. THAT we are executing this affidavit to attest to the veracity of the foregoing
stipulations for purposes recording and registering the facts of birth of
____________________ with the LCR- Cebu City and the National Statistics Office,
and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunder affixed my signature on this affidavit

of guardianship this 11th day of April 2013, in Cebu City, Philippines.

____________________ ____________________
Affiant Affiant
TIN: ____________________ TIN: ____________________

SUBSCRIBED AND SWORN to before me, a notary public, on the date and place
abovementioned; affiants’ identities I have ascertained thru their respective
government-issued ID card as per data indicated below their names.

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2013.