Republic of the Philippines ]

Province of Bohol ]
Municipality of Carmen ] S.S.

SELF-AFFIDAVIT
(Re: Late Birth Registration)

I, FELIX LITUB, Filipino, of legal age, married and a resident of Upper Suba,
Katipunan, Carmen, Bohol, Philippines, after having been duly sworn in accordance with law, do
hereby depose and state:

1. That I was born on May 30, 1958 at Buenos Aires, Carmen, Bohol, the son of
Hipolita Litub;

2. That upon checking the records of the Philippine Statistics Authority, I found out that
my birth record is not found in their office;

3. That I was on the belief that the registration of my birth was already processed at our
Local Civil Registrar (LCR) in Carmen, Bohol, Philippines;

4. That I was surprised to find out that the record of my birth is not existing in the
records of our LCR;

5. That I am executing this affidavit to support the application for the late registration of
my birth at the LCR, Carmen, Bohol, Philippines;

6. That I further attest to the truth of the foregoing statements for whatever other legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of April, 2023 at
Carmen, Bohol, Philippines.

FELIX LITUB
Affiant
National ID No. 3423-6437-9650-7618
Issued by the Philippine Statistics Authority (PSA)

SUBSCRIBED AND SWORN TO before me this 28th day of April, 2023 at Carmen,
Bohol, Philippines.