AFFIDAVIT OF DELAYED REGISTRATION OF BIRTH

We, CRISANTO ALILAM and ROWENA AGUANTA, Filipino, of legal age, single/married, and presently
residing at Sta. Cruz, Ballesteros, Cagayan, after having been duly sworn to in accordance with the law,
hereby depose and say:

That we are the parents of the child ROCHELLE A. ALILAM, who was born on September 04, 2004 in
Sta. Cruz, Ballesteros, Cagayan.

The reason for the delayed registration of his/her birth is:

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We are 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.

FURTHER AFFIANTS SAYETH NAUGHT.

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Signature of Affiant over Printed Name Signature of Affiant over Printed Name