REPUBLIC OF THE PHILIPPINES)

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

AFFIDAVIT OF LATE OUT OF TOWN REGISTRATION

I, DEBBIE D. BUENDIA, daughter of MARCELINA TOYHACAO DELUTE, of legal

age, Filipino, single, with residence at Victorias City, Negros Occidental, after first being duly
sworn according to law, depose and say:

1. That I am the applicant for the delayed registration of my Certificate of Live Birth
before the Office of the Civil Registrar of Victorias City, Negros Occidental;

2. That I was born on June 01, 1982 at Hinigaran, Negros Occidental, through my
parents ROGELIO DAVID SEDANTES and CRISTETA DEBOLGADO CARLOS;

3. That due to inadvertence, my certificate of live birth was not reported and recorded in
the Office of the Civil Registrar of Hinigaran, Negros Occidental, and the Philippine
Statistics Authority, Manila;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and
appraise the authorities concerned for the belated registration of my Certificate of
Live Birth;

5. That I am requesting the Civil Registrar of Hinigaran, Negros Occidental to process

and endorse my certificate of Live Birth to the Office of the Civil Registrar General
pursuant to Rule 20 of A.O. No. 1, Series of 1993.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

_________________ 2020 at Victorias City, Negros Occidental.

ROSE SEDANTES SANCHEZ

Affiant
__________________________

CORROBORATING STATEMENT

We, ____________________________and _____________________________, both of

legal age, married/single, Filipinos, and residents of Victorias City, Negros Occidental,
Philippines, do hereby depose and say that the foregoing statements are true and correct
according to our knowledge and belief.

__________________________ _____________________________
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 2020