Republic of the Philippines )

Province of Cavite ) S.S.

Trece Martires City )

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSON

(In Re: LATE REGISTRATION OF BIRTH)

WE, MYLENE N. LIMBO and JEMERSON S. COLUMNA, both of legal age, Filipino citizens,
with office address at Digma Commercial Center, Brgy. Luciano, Trece Martires City, Cavite,
under oath states that:

1. We personally know BEATRISH MOSCOSA ENCABO who was born on 19 August

2016 at General Emilio Aguinaldo Mem. Hospital, Trece Martires City, Cavite,
Philippines to Benessa Mengote Moscosa and Rodulfo Tul-Iel Encabo;

2. We have personal knowledge that BEATRISH MOSCOSA ENCABO has no record of

birth as corroborated herein by the appended Negative Certification of Birth issued
by the Philippine Statistic Authority (PSA for brevity);

3. The reason thereof the parents of BEATRISH MOSCOSA ENCABO were not able to
register her birth due to busy schedules;

4. We are not related to her either consanguinity or affinity up to fourth civil degree;

5. We are executing this affidavit to attest to the truthfulness of the foregoing

declaration and in support with the cause of the late registration of birth of
BEATRISH MOSCOSA ENCABO;

6. We are further executing this affidavit to formally request the Local Civil Registrar of
Trec Martires City, Cavite to register the birth of BEATRISH MOSCOSA ENCABO and
for all legal intents and purposes this may suit best.

IN WITNESS WHEREOF, we have hereunto set our hand this 9th day of June 2021 at Trece
Martires City, Cavite, Philippines.

MYLENE N. LIMBO JEMERSON S. COLUMNA

Affiant Affiant
VIN Id. No.: 2122-0039A-L0677MNL20001-2 PhilHealth Id. No.: 08-025551602-0

SUBSCRIBED AND SWORN to before me on this 9 th day of June 2021 at Trece Martires
City, Cavite. The affiant exhibited to me their competent proof of their identification, and
avowed to me the foregoing facts and declarations.

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R.A. NO. 9255 Form No.1

 Registry Number __________________
Republic of the Philippines)
Province of Cavite )S.S.
Trece Martires City )

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, FLORDELIZA TOL-ID DE PAZ, of legal age, married, Filipino citizen, and a resident of #9001 Belaro
Compound Phase IV, Brgy. Paliparan 3, Dasmariñas City, Cavite, after having been duly sworn to in accordance with
law, do hereby declare that:

1. I am seeking to use the surname ENCABO in:

a) my Certificate of Live Birth/Report of Birth, pursuant to R.A. 9255 and its Revised IRR.
b) the Certificate of Live Birth/Report Birth of BEATRISH MOSCOSA ENCABO
√
who is my GRANDDAUGHTER;

2. She was born on 19 August 2016 at TRECE MARTIRES CITY, CAVITE, Philippines.

3. The birth was recorded under Registry Number _____________ on ___________________;

4. The Affidavit of Admission of Paternity of the Private Handwritten instrument was recorded under
Registry No. (Registry Number) on (date of Registration) at the Local Civil Registry Office
(LCRO)/Philippine Foreign Service Post (PFSP) (City/Municipality) (Province) (Country/State);

5. I am filling this AUSF at the LCRO/PFSP of TRECE MARTIRES CITY, CAVITE, Philippines, in accordance
with R.A. 9255 and Its Revised Implementing Rule and Regulations.

6. I hereby certify that the statements made herein are true and correct to the best of my knowledge
and belief.

7. In witness whereof, I hereby affix my signature on this 9 th day of June 2021 at Trece Martires City,
Cavite, Philippines.

FLORDELIZA TOL-ID DE PAZ

Signature Over Printed name of Affiant

SUBSCRIBED AND SWORN to before me on this 9 th day of June 2021 in Trece Martires City, Cavite,
Philippines, affiant exhibiting her TIN Identification bearing the number 389-610-182-00000 as her competent
proof of her identity.

I certify that I personally examined the affiant and that she voluntarily executed the foregoing affidavit
and understood the contents thereof.

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Republic of the Philippines )

Province of Cavite ) S.S
City of Trece Martires )

AFFIDAVIT OF GUARDIANSHIP
 I, RODULFO TUL-IEL ENCABO JR., of legal age, single, Filipino citizen, and a resident of
Blk. 209 Excess Lot Phase 5, Paliparan 3, Dasmariñas City, Cavite, Brgy. Inocencio, Trece
Martires City, Cavite, after having sworn to in accordance with law, hereby depose and state:

1. That I am the guardian/biological father of BEATRISH MOSCOSA ENCABO who was

born on 19 August 2016 at General Emilio Aguinaldo Mem. Hospital, Trece Martires
City, Cavite, Philippines. To corroborate this claim the Certificate of Live Birth are
faithfully reproduced and hereto appended;

2. That I am presently causing an application for Late Registration of birth of my child

at the Local Civil Registrar of Trece Martires City, Cavite, Philippines;

3. That due to the absence of her mother BENESSA MENGOTE MOSCOSA due to she
working abroad, I have a full custody to a minor BEATRISH MOSCOSA ENCABO;

4. Through this affidavit, I hereby affirmed that I am the guardian of BEATRISH

MOSCOSA ENCABO;

5. That I am executing this affidavit to attest the truthfulness of the foregoing

declarations under penalties of perjury to support the cause herein specified and
to further support all other legal intents ;

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESSWHEREOF, I hereby affix my signature on this 9 th day of June 2021 at

Trece Martires City, Cavite.

RODULFO TUL-IEL ENCABO JR.

Affiant
TIN Id. No.: 379-972-637-000

SUBSCRIBED AND SWORN TO BEFORE ME on this 9th day of June 2021 at Trece
Martires City, Cavite. Affiant exhibiting to me his competent proof of his identity as reflected
above, and avowed to me the foregoing facts and declarations.

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Republic of the Philippines )

Province of Cavite ) S.S
City of Trece Martires )

AFFIDAVIT OF GUARDIANSHIP
 I, FLORDELIZA TOL-ID DE PAZ, of legal age, married, Filipino citizen, and a resident of
#9001 Belaro Compound Phase IV, Brgy. Paliparan 3, Dasmariñas City, Cavite, after having
sworn to in accordance with law, hereby depose and state:

1. That I am the guardian/grandmother of BEATRISH MOSCOSA ENCABO who was

born on 19 August 2016 at General Emilio Aguinaldo Mem. Hospital, Trece Martires
City, Cavite, Philippines. To corroborate this claim the Certificate of Live Birth are
faithfully reproduced and hereto appended;

2. That I am presently causing an application for Late Registration of birth of my child

at the Local Civil Registrar of Trece Martires City, Cavite, Philippines;

3. That due to the absence of her mother BENESSA MENGOTE MOSCOSA due to she
working abroad, and due to the absence of her father RODULFO TUL-IEL ENCABO JR.
due to his busy schedule from his work I have a full custody to a minor BEATRISH
MOSCOSA ENCABO;

4. Through this affidavit, I hereby affirmed that I am the guardian of BEATRISH

MOSCOSA ENCABO;

5. That I am executing this affidavit to attest the truthfulness of the foregoing

declarations under penalties of perjury to support the cause herein specified and
to further support all other legal intents ;

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESSWHEREOF, I hereby affix my signature on this 9 th day of June 2021 at

Trece Martires City, Cavite.

FLORDELIZA TOL-ID DE PAZ

Affiant
TIN Id. No.: 389-610-182-00000

SUBSCRIBED AND SWORN TO BEFORE ME on this 9th day of June 2021 at Trece
Martires City, Cavite. Affiant exhibiting to me her competent proof of her identity as reflected
above, and avowed to me the foregoing facts and declarations.

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