Republic of the Philippines )

___________ ) S.S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, _____________________ and ___________________, both Filipinos, of legal

ages, residing at __________________________________, after having been duly
sworn to in accordance with law, do hereby depose and say;

1. That we personally know _______________________, the daughter of

__________________ and ________________________, being an intimate friend
of our family in __________________________________;

2. That she was born on __________________ at __________________, and that

the said birth was not registered at the Local Civil Registry Office of ____________,
because she was birthed at the family household without the assistance of
registered medical professional;

3. That we are not related to the said person either by consanguinity or by affinity
nor do we have any pecuniary interest whatsoever;

4. That we are executing this affidavit to affirm the true facts of the birth record of
________________________ who would want to avail of late registration of birth
at the Office of the Civil Registry of _____________.

IN WITNESS WHEREOF, we hereunto set our hands this __ day of ____________

at _______________, Philippines.

__________________________ __________________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _________ at Cebu

City, Cebu, Philippines, affiants personally appearing before me, presenting their
competent evidence of identity appearing below their names.

Doc No. _______;

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