Republic of the Philippines )

Province of Bataan ) S.S.

City of Balanga )
x------------------------------x

AFFIDAVIT OF LATE REGISTRATION OF BIRTH

AND DISCREPANCY IN FAMILY NAME

I, FRANKLIN BAUTISTA SEGUNDO, of legal age, Filipino, single

and presently residing at Barangay Nagwaling, Pilar, Bataan, under oath
depose and say:

1. That I was born on January 29, 1990 in Orion, Bataan to parents

FRANCISCO BELLET SEGUNDO and LIGAYA VILLANUEVA BAUTISTA;

2. That when I was learning how to write, I was taught to write

the family name SIGUNDO. I used the said family name in school during
elementary and high school years;

3. That unaware of the legal consequences, I continued using the

family name SIGUNDO in my other dealings even though my parents and
siblings use the family name SEGUNDO to avoid discrepancy in my school
records;

4. That when I came to age and began to work, I register with

Social Security System (SSS) and I remember using the family name
SIGUNDO;

5. That just recently, I came to SSS Balanga Branch to verify my

monthly contributions and presented my Philhealth Identification (ID) card
and my company ID bearing the family name SIGUNDO. Discrepancy in my
family name as shown in my IDs and in the SSS records was noticed. It
appears that my family name was recorded therein as SEGUNDO and not
SIGUNDO;

6. That I requested a copy of my Certificate of Live Birth from the

Philippine Statistics Authority (PSA) and I was issued a Negative Certification
of Birth, photocopy of which is hereto attached and marked as Annex A. When
I proceeded to the Office of the Local Civil Registrar of Orion, Bataan, I did
not find the record of my birth either;

7. That I am now applying for the delayed registration of my birth;

8. That I would like also to request that my family name be

registered as SEGUNDO and not SIGUNDO because the correct spelling of the
family name of my father is SEGUNDO as can be seen in the Certificate of
Marriage of my parents, in the Certificates of Live Birth of my siblings and in
my Certificate of Baptism;
 9. I am executing this affidavit to attest to the truth of the
foregoing and to establish that my family name is SEGUNDO and to request
that my birth be registered at the Office of the Local Civil Registar of Orion,
Bataan.

IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day

of January 2020 here at Balanga City, Bataan.

FRANKLIN B. SEGUNDO
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of January 2020

here at Balanga City, Bataan.

ATTY. FERNANDO S. MENDOZA II

NOTARY PUBLIC
BALANGA CITY, BATAAN
UNTIL DECEMBER 31, 2020
PTR NO. 5377184, JAN. 3, 2020
Doc. No. _____; IBP LIFETIME NO. 06325
Page No. _____; ROLL OF ATTORNEY NO. 50966
Book No. _____;
Series of 2020.