REPUBLIC OF THE PHILIPPINES }

PROVINCE OF LAGUNA }S.S.

MUNICIPALITY OF STA CRUZ }

AFFIDAVIT OF TWO DISINTERESTED PERSONS

We ________________________________ and ___________________________,both of legal

ages, and residence of Barangay Bagumbayan Sta Cruz Laguna, after having sworn to an oath in
accordance with the law, do hereby depose and state: THAT-

1. We are not related by blood or by law to Angela Nichole Ramos

2. We personally know the facts and circumstances surrounding the birth of the person of
ANGELA NICHOLE RAMOS who was born to RYAN MEDINA REYES and JENNIFER
PERBER RAMOS on April 17, 2013 in Dubai UAE;
3. That the said child was born outside wedlock;
4. That the birth of the child was attended by a roommate nurse in Dubai
5. That the said was immunized and was baptized at Immaculate Concepcion Catholic
church in Sta Cruz Laguna.
6. The birth certificate of the said child was not immediately registered with the Office of
the Municipal Registrar.
7. We are executing this affidavit freely and voluntarily to attest to the foregoing narration
of facts of the child, and to support the application for delayed registration of the same
with the Office of the Municipal Civil Registrar, and for whatever legal purpose and
interest this may serve.

AFFIANT AFFIANT

IN WITNESS WHEREOF, we have hereunto set my hands this ____of______________________

year 2023 in Sta. Cruz, Laguna.