Republic of the Philippines)

Province of Pangasinan ) S.S.

Municipality of San Jacinto)
x----------------------------------------x

AFFIDAVIT OF TWO DISINTERESTED PERSONS

(Re: Late/Delayed Registration of Birth)

            We, MIRASOL R. RAMOS and GRACE A. BAUTISTA, both of legal ages,

Filipino citizens, and with the residence address at San Jacinto, Pangasinan, after having
been duly sworn and oath in accordance with law hereby voluntarily depose and say:

1.  That we personally known AIRENE ARABELLA SINEN ISLA ,

daughter of ALVIN D. ISLA and MERRIE ANGELA S. SINEN, who was
born on 25th day of November 2022 at Medical Centrum, Dagupan City,
Pangasinan, Philippines;

2.  That due to the negligence and/or inadvertence on the part of her parents and
the prevailing conditions then, her birth was not registered;

3.  That we have first-hand knowledge of the foregoing facts because we together

with our respective families, being their acquaintances and close family friends
in the province;

4. That we are not related to , AIRENE ARABELLA SINEN ISLA by

consanguinity or affinity;

5.  That we are executing this Affidavit to attest to the truth of all the foregoing
facts, in connection with the application for the late/delayed registration of
birth of the said AIRENE ARABELLA SINEN ISLA, and for whatever
legal purpose this may serve.

IN TRUTH WHEREOF, we have hereunto set our hands this 26th day of April
2023 at San Jacinto, Pangasinan, Philippines.

MIRASOL R. RAMOS GRACE A. BAUTISTA

Affiant Affiant
C RN No.: 0033-8772871-4 VIN N o.: 5534- 0013B-A3085GAB20000

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and

for San Jacinto, Pangasinan, this 26th day of April 2023. Affiants personally came and
appeared to my office, personally known to me and to me known to be the same person
who personally signed the foregoing instrument before me and avowed under penalty of
law to the whole truth of the contents of said instrument.

ATTY. ANNA MARI E. ABARCAR

Doc No. 415; NOTARY PUBLIC
Page No. 84; Until December 31, 2023
Book No. XIV; Roll of Attorney’s No.68056
Series of 2023. PTR No. 9798269/ 03 Jan 23
IBP No. 261088/ 03 Jan 23
Capaoay, San Jacinto, Pangasinan