REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S

AFFIDAVIT OF LATE
REGISTRATION OF BIRTH
KNOW ALL MEN BY THESE PRESENTS:

I, MAURA ESPINOZA CLIMACO, Filipino, of legal age and a resident of P-1,

St. Paul District, Mangagoy, Bislig City, Surigao del Sur, after having been duly
sworn to in accordance with law, hereby depose and state, THAT:

1. I am an applicant for late registration of birth.

2. I was born in Tago, Surigao del Sur on July 13, 1957.

3. I was delayed in registering my birth for the reason that my parents

failed to register my birth as we transferred in another municipality
when I was born.

4. It was only recently, when I inquired from the Philippine Statistics

Authority, I found out that my birth was not registered.

5. I execute this affidavit to attest to the truth of the foregoing and

whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have here unto set my hand this 16 th day of

March 2021 in the City of Bislig, Province of Surigao del Sur.

MAURA ESPINOZA CLIMACO

Affiant
I.D. No. _______________

SUBSCRIBED AND SWORN to before me on the date and place first above
written.

Doc. No. ____;

Page No. ____;
Book No. II;
Series of 2021.