Professional Documents
Culture Documents
3 A
City / Municipality of ___________ ) S.S.
_______________________________ )
Province of ____________________)
LEGITIMATE/ LEGITIMATED/ DATE/ PLACE OF BIRTH (if minor, give name, address and
LEGALLY ADOPTED CHILDREN relationship of guardian)
MOTHER/FATHER ADDRESS
(if dead, give date and place of death instead)
LEGALLY MARRIED?
YES NO
That affiant further certify that the documents establishing the fact/s of
__________________ such as the ______________________ could not be submitted for the
following reasons: __________________________________________________________________
FURTHER, AFFIANT SAYETH NAUGHT.
AFFIANT
NOTARY PUBLIC
Until_______________________
DOC NO.: ______________________