Republic 

of the Philippines )
Province of Palawan )S.S.
City of Puerto Princesa )

AFFIDAVIT OF DELAYED REGISTRATION OF BIRTH

         I, MARIA B. DELA CRUZ, of legal age, Filipino, single and a resident of
___________ Street, Pio del Pilar, Puerto Princesa City, after having been duly sworn to
in accordance with law, depose and state:

1. That I am the applicant for the delayed registration of birth of my son Pedro Dela Cruz;

2. That he was born in Puerto Princesa City on October 25, 2012;

3. That I was delayed in registering his birth for the reason that
_______________________________________________________ .

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

         IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of January
2023 in Puerto Princesa City, Palawan, Philippines.
          

MARIA B. DELA CRUZ

Affiant

    SUBCRIBED AND SWORN TO before me this 6th day of September 2013 in Makati

City, Metro Manila, Philippines, affiant exhibiting to me her Philippine Passport No.
123456 issued in Manila on January 12, 2012 and valid until January 12, 2017.

Doc. No. ______; ATTY. JOEMAR P. CALUNA

Page No. ______; NOTARY PUBLIC
Book No. ______; UNTIL DECEMBER 31, 2023
Series of 2023 PURSUANT TO BAR MATTER NO. 3795
PTR. 1705611/07/18/2022
IBP NO. 230900/06/11/12
ROLL NO. 82822
NPL NO. 2022-05