Republic of the Philippines )

City of Iriga ) S.S.

AFFIDAVIT OF NO SUPPORTING DOCUMENTS

KNOW ALL MEN BY THESE PRESENTS:

I, ARNOLD ROSAS AQUINO, of legal age, single, Filipino citizen, and with residence
and postal address at Zone 7, San Nicolas, Iriga City, Camarines Sur after having been duly
sworn to in accordance with law, hereby depose and say:

1. That I am applying for the late/delayed registration of my birth with the Local Civil
Registrar of Iriga City, Camarines Sur;

2. That the requirements to be submitted to support the late/delayed registration of my

birth are the following: Parents Marriage Contract, School Reward, School Records,
Voter’s Registration and Birth Certificate/Baptismal Certificate;

3. That I have no personal knowledge of the fact of the marriage of my parents since
they were already deceased while I was still in my tender years and no official
documents/official records of the above-mentioned documents exist as proof of
marriage, thus, they have no marriage certificate; that due to constant change/transfer
to various schools, no school records exist and I have not received any school awards;
that I am not a registered voter, thus, no voter’s registration record exist; and I have
no Birth Certificate/Baptismal Certificate, since my birth have not been registered and
I have not been baptized by the church or by any of the religious affiliations in the
Philippines;

4. That the only identification card or public document I have in order to support the
late/delayed registration of my birth are the following: Philippine Identification Card
No. 4053-8493-6879-4218, PhilHealth ID No. 10-202633319-6, and SSS No. 04-
3257354-5;

5. That I am executing this Affidavit to attest to the truth of the foregoing facts, in
connection with my application for late/delayed registration of my birth with the
Office of the Local Civil Registrar of Iriga City, Camarines Sur.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of May 2023 at Iriga
City, Camarines Sur.

ARNOLD ROSAS AQUINO

Affiant
SUBSCRIBED AND SWORN to before me this _______ day of _______________, Iriga
City, Philippines. Affiant exhibited his identification indicated below his name to establish his
identity as the same person who executed and personally signed the foregoing affidavit.

Doc No. _______;

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