Republic of the Philippines )

Tacloban City ) S.S.

AFFIDAVIT OF DELAYED REGISTRATION OF BIRTH

I, ARIANE MAY O. MISTA of legal age, Filipino, single, and a resident of Brgy. 101
Kawayan, Tacloban City, after having been duly sworn to in accordance, with law, do hereby
depose and state that

1. I am the mother ZHAINE M. MALATE who was born on February 19, 2019 in Tacloban
City. Her father is GERALD R. MALATE.

2. The birth of said ZHAINE M. MALATE is not registered in the Office of the Civil Register
of Tacloban City;

3. The facts of the birth were not promptly reported at the Local Civil Register of
Tacloban City because of inadvertence;

4. That I am executing this Affidavit to attest to the truth of the foregoing allegations to
support the application for delayed registration of the same with the Local Civil
Register Tacloban City, and for any legal intents and purposes that this Affidavit may
serve.

IN WITNESS THEREOF, we have set out hands this 30 July 2022 in Tacloban City.

ARIANE MAY O. MISTA

Affiant
PhilHealth No. 13-025338134-6

CORROBORATION

We, JENILYN DEL PILAR NAPURAN and CONSORCIA M. ROSEL, both of legal age, Filipino
citizens and residents of Tacloban City, after having been duly sworn to in accordance with
law, do hereby depose and state that:

We personally declare the above-statements of ARIANE MAY O. MISTA to be true and

correct to the best of our knowledge and belief, having known her and her daughter for a long
time already.

JENILYN DEL PILAR NAPURAN CONSORCIA M. ROSEL

Affiant Affiant
Philippine Identification Card No: OSCA ID No. 3603066
4053-1521-3672-9176 08/19/14, Tacloban City

SUBSCRIBED AND SWORN to before me this 30 July 2022 in Tacloban City, affiants
having exhibited to me their government-issued identification card as competent proof of
their identity as mentioned above.

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Series of 2022.