REPUBLIC OF THE PHILIPPINES )

Quezon City, Metro Manila ) S.S.

AFFIDAVIT OF NO RECORD OF BIRTH

I, ________________, of legal age, single/married and a resident

of ____________________________________, after having been duly sworn
to in accordance with law, hereby depose and state:

1. THAT my date of birth is on ______________ at Quezon City,

Metro Manila;

2. THAT my father is __________ and my mother is

_________________;

3. THAT on __________________, I went to the Philippine

Statistics Authority (Office of the Civil Registrar General) to
inquire and secure a copy of my record of birth or birth
certificate;

4. THAT said Office issued a certification stating among others

that they do not have any record of my birth;

5. THAT, I am executing this Affidavit to attest to the truth of

the foregoing facts and to use the same for whatever legal
purpose it may serve.

Further, Affiant sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature this __ th

day of ______________, ________ at Quezon City, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______day of

______________2022 at Quezon City, Affiant exhibiting to me
his _________________________________ issued by ____________________ and will
expire on ___________________.

Notary Public
Doc. No. : _______
Page No. : _______
Book No. : _______
Series of 2022.