Republic of the Philippines )

Province of Cebu )
Municipality of Balamban )S.S.

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

I, JENELYN EGLOSO ARCABAL, of legal age, single, and with residence and postal
address at Balamban, Cebu, after having been duly sworn to in accordance with law, do
hereby depose and say:

1. That I am the applicant for the delayed registration of the birth of my daughter
ANGEL ARCABAL;

2. That she was born on October 10, 2019, at Balamban, Cebu;

3. That I delivered her in the Birthing Center of Balamban, Cebu but I could no
longer remember the midwife who attended her at birth;

4. That I am a Filipino Citizen;

5. That the reason for the delay in registering my daughter’s birth was due to the
fact I was sick and was not able to go back to the hospital and process her
registration;

6. That a copy of her birth certificate is needed for the purpose of late registration
and to have a record in the Philippine Statistics Office.

JENELYN EGLOSO ARCABAL

Affiant
CTU – School ID No. 8170333

SUBSCRIBED AND SWORN to before me this 29 TH day of May, 2021, in

Balamban, Cebu, Philippines. affiant exhibiting to me his valid proof of identification as
shown above.

Doc No._____;
Page No. _____;
Book No._____;
Series of 2021.