REPUBLIC OF THE PHILIPPINES)

MALOLOS CITY, BULACAN )SS.

AFFIDAVIT OF DELAYED
REGISTRATION OF BIRTH

I, MARY ANNA TREXIA CRUZ ESPELA of legal age, Filipino citizen, a resident of No.
515 Looban St. Siling Matanda, Pandi, Bulacan, after having been sworn to in accordance
with law hereby depose and say that:

1. I am the applicant for the delayed registration of my birth;

2. I was born in Silangan Park Marulas, Valenzuela City on 18 TH Day of FEBRUARY

1997;

3. I was delayed in registering my birth for the reason that the midwife who file my
certificate of live birth was failed to file it in the Local Civil Registry;

4. It was only recently, when I applied for PSA authenticated birth certificate, that I
found out that my birth was not registered;

5. I am executing this affidavit to attest to the truth and veracity of the foregoing
facts and in compliance with the requirements of the Philippines Civil Registrar.

IN WITNESS WHEREOF, I have hereunto set my hand on this 5 TH Day of

SEPTEMBER 2022 at MALOLOS CITY, BULACAN

MARY ANNA TREXIA CRUZ ESPELA

Affiant

SUBSCRIBED AND SWORN to before me this 5TH Day of SEPTEMBER 2022 at

MALOLOS CITY, BULACAN.

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2022