REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC : S.S.

MUNICIPALITY OF BAMBAN )

JOINT AFFIDAVIT

We, _________________________ and _________________________, both of legal age,

Filipinos, married, with residence and postal address at Capas, Tarlac 2315,
Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say:

THAT—

1. We personally know _________________________ of Villa de Sto. Rosario,

Brgy. Sto. Rosario, Capas, Tarlac;

2. We know that on August 17, 2010 at District Hospital, Concepcion,

Tarlac, _________________________gave birth to a baby girl who was given
the name _________________________;

3. We also know that the fact of birth of _________________________was not

registered at Local Civil Registrar of _________________________,
Philippines, and to the National Statistics Office (NSO), Manila, due to
negligence, a copy of her Baptismal Certificate is attached as Annex “A”
to form an integral part hereof;

4. We are executing this Joint Affidavit to attest to the truth of all the
foregoing; to show the proper authorities concerned the fact of birth of
_________________________; and to have her birth registered at the Local
Civil Registry of Concepcion, Tarlac, and to the National Statistics
Office, Manila;

IN WITNESS WHEREOF, we have hereunto affixed our signatures this 29 th

day of May 2014, at Bamban, Tarlac 2317, Philippines.

_________________________ _________________________
Affiant Affiant
Municipality of Municipality of
ID No. MCR-003 ID No. MO-0038

SUBSCRIBED AND SWORN to before me this 29 th day of May 2014 at

Bamban, Tarlac, Philippines, affiants exhibited to me their positive identifications
duly noted above below their names and signatures, known to me and to me
known to be the same persons who executed foregoing instrument and
acknowledged to me that the same is their free act and deed and that she
voluntary executed the same and understood all the contents thereof.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. XII;
Series of 2014.