REPUBLIC OF THE PHILIPPINES }

PROVINCE OF ______________ }
MUNICIPALITY OF ___________ } S.S.

AFFIDAVIT OF BIRTH

I, _______________________________________, of legal age, Filipino, ____________,

and presently residing at ________________
_________________________________________________, after having been duly
sworn to in accordance with law, depose and state:
1. I was born on ___________ ____, ______, in _______________, to spouses
________________________ and ________________________;
2. This is supported by numerous authentic documents attached in this affidavit; and I
hereby certify that the foregoing statements are correct.
3. I therefore have executed this Affidavit to attest the truth I mentioned herein and for
whatever legal purposes it may serve.

_______________________________
XXXXXXXXXXXXXXX
Affiant
ID No.___________
Issued on ___________
Place of Issue: ______________

SUBSCRIBED AND SWORN to before me at

____________________Philippines this________________, 2021, affiant exhibiting
before me her Competent Evidence of Identity written below her name and signature,
that she is the same person who personally signed before me the foregoing Affidavit
and acknowledged that she executed the same.