REPUBLIC OF THE PHILIPPINES)

QUEZON CITY )S.S.

AFFIDAVIT
(Re: Entries in Certificate of Live Birth)

I, MYLA ATIENZA BAYER, of legal age, single, Filipino

citizen and with residential address at Block 5, Lot 10, Samarloop
Street, Macaria Villa, Biñan, Laguna, after having been sworn to in
accordance with law hereby depose and say;

1. That I am the mother of KIRSTEN XYRA ATIENZA

BAYER, whom I gave birth on 25 September, 2007;

2. That at the time I gave birth to my daughter, her father

ROBERT NIÑO DEL ROSARIO MELGAREJO
acknowledged my daughter as his daughter also,
although aside from such unfortunate incident where we
meet, we never lived as husband and wife thereafter and
continues to do so at present where his whereabouts is
totally unknown to me and my daughter;

3. That after the lapse of almost one (1) year from the birth
of my daughter and while I was planning to have my
daughter baptized, I inquired from the Civil Registry of
Quezon City about the Certificate of Live Birth of my
daughter, only to found out that she was not registered
by his father, although I signed a Certificate of Live Birth
while I was still on my hospital bed;

4. Hence, on August 15, 2008, I immediately caused the

registration of my daughter through delayed registration
after finding from the Quezon City Hall that she has no
registration records, a copy of her Certificate of Live Birth
is hereto attached and marked as ANNEX “A”;

5. That sometime this 1st week of January, 2013, I requested

for a Certified True Copy of the Certificate of Live Birth of
my daughter from the National Census and Statistics
Office (NCSO), only to find out that my daughter was
likewise belatedly registered by his father on July 08, 2008
or almost a year after her birth, where my daughter was
registered using the surname of her father to wit:

KIRSTEN XYRA BAYER MELGAREJO

Page 1 of 2
 Copy of the Certificate of Live Birth is hereto attached as
ANNEX “B”;

6. That I categorically declare under oath that since the birth

of my daughter, her father never gave support to her and
worst, nowhere to be found, leaving the obligations of
rearing our daughter solely to myself and no one else;

7. That this affidavit is hereby set in order to attest to the

truth of the foregoing facts and circumstances and in
order to request from the Civil Registry of Quezon City to
allow my daughter to use her name as KIRSTEN XYRA
ATIENZA BAYER only; so as to erase the agony of a lost
and irresponsible father;

8. That I am executing this affidavit in order to attest to the

truth and the foregoing circumstances behind my
daughter’s true and correct identity, such registration is
not intentional nor intended to misled other parties,
evade liabilities and any other purposes contrary to law;

FURTHER, AFFIANT SAYS NOTHING.

Done this 31st day of January, 2013, Quezon City, Philippines.

MYLA ATIENZA BAYER

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for

and in Quezon City, this 31st day of January, 2013.

Doc. No. _____ NOTARY PUBLIC

Page No. _____
Book No. _____
Series of 2013

Page 2 of 2