REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NORTHERN SAMAR ) S.S.

MUNICIPALITY OF GAMAY )

AFFIDAVIT OF DELAYED
REGISTRATION OF DEATH

I, RONNIE N. MACAYAYONG, of legal age, single, a Filipino

Citizen, and a resident of Brgy. Magtaon, Mapanas, Northern Samar,
Philippines, after having been duly sworn to in accordance with the law
do hereby depose and state:

1. That my father ROMEO A. MACAYAYONG died on June 30,

2022 at Magtaon, Mapanas, Northern Samar;

2. That the cause of the death of my father was complications

due to his high blood pressure;

3. That the reason for the delay in registering the death of my

father was due to the fact that we did not know that it should
be registered;

4. That I am executing this affidavit to attest to the truthfulness

of the foregoing statements and for all legal intents and
purposes this document may rightfully serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th

day of August 2022, at Gamay, Northern Samar, Philippines.

RONNIE N. MACAYAYONG
Affiant
DSWD HHID No. 084812004-2-10379243

SUBSCRIBED AND SWORN to before me 9th day of August

2022 at Gamay, Northern Samar by Ronnie N. Macayayong, who has
satisfactorily proven to me his identity through his identification card
as indicated above.

Doc. No.______;
Page No.______;
Book No.______;
Series of 2022.