REPUBLIC OF THE PHILIPPINES)

; .S.S
VICTORIAS CITY )
X------------------------x

JOINT AFFIDAVIT FOR LATE REGISTRATION

We, _________________________ and ________________________,

both of legal age, Filipinos, with residence at Victorias City, Negros Occidental,
after first being duly sworn according to law, depose and say:

1. That we personally know MARY CHARITY FATE L. SOMBERO who

is a resident of Victorias City, Negros Occidental;

2. That she has a child by name of GRAZEL FATE SOMBERO who was
born on October 5, 2007 at Victorias, Negros Occidental;

3. That we know this for a fact because we were friends and neighbors in
our small community in Victorias City, Negros Occidental;

4. That we are executing this affidavit in order to state the fact of birth of
the said GRAZEL FATE SOMBERO who was not registered with the
Office of the Civil Registrar of Victorias City, Negros Occidental due to
lack of awareness of the requirement, and to avail the late registration of
her birth.

IN WITNESS WHEREOF, we have hereunto affixed our signatures this

___ day of _________________ 2020 at Victorias City, Negros Occidental.

Affiant Affiant

SUBSCRIBED AND SWORN to before me this _____ day of

____________ 2020 at Victorias City, Negros Occidental, Philippines.

Doc. No. ___________

Page No. __________
Book No. _________
Series of 2020