REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S

AFFIDAVIT OF LATE
REGISTRATION OF BIRTH
KNOW ALL MEN BY THESE PRESENTS:

I, ABCDE FGHIJ KLMNO, Filipino, of legal age, married and a resident of

Poblacion, Karat City, Surigao del Sur, after having been duly sworn to in
accordance with law, hereby depose and state, THAT:

1. I am an applicant for late registration of birth.

2. I was born in Dapa, Surigao del Norte on March 04, 1960.

3. I was delayed in registering my birth for the reason that my parents

failed to register my birth as we transferred in another municipality
when I was born.

4. On September 26, 1989, I was married to ABCDE FGHIJ KLMNO.

5. Before my marriage, my full name was ABCDE FGHIJ KLMNO.

6. I execute this affidavit to attest to the truth of the foregoing and

whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have here unto set my hand this 17 th day of

March 2023 in the City of Bislig, Province of Surigao del Sur.

ABCDE FGHIJ KLMNO

Affiant
I.D. No. _______________

SUBSCRIBED AND SWORN to before me on the date and place first above
written.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2023.