Republic of the Philippines )

City of Dasmariñas Cavite )S.S

AFFIDAVIT OF DELAYED REGISTRATION OF BIRTH

I, MARY ANN A. GAGANTE, of legal age, single and presently residing at Blk 12 Lot
8 Purok 2 Brgy. Victoria Reyes Dasmariñas Cavite, after being duly sworn to in accordance with
law, depose and say;

1. That I am the applicant for the delayed registration of birth of my sibling Virginia
Anne Alejo Gagante;

2. That the birth of Virginia Anne Alejo Gagante was attended by local hilot, of
Barangay Victoria Reyes, Dasmariñas Cavite on December 21, 2005;

3. That the said birth was not immediately registered with the Office of the Local
Registrar, primarily because of the inadvertence of the parents or failure of the person
delegated to do so, hence, this Affidavit;

4. That we are acquiring this birth certificate as it is one of the school requirement for
graduation; and

5. That I am executing this Affidavit to attest the veracity of the foregoing and in
compliance with the requirements of the Local Civil Registrar of the Municipality of
Dasmariñas Cavite, relative to the application for the delayed registration of the birth
of Virginia Anne Alejo Gagante and for other legal purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of July, 2023, at the
City of Dasmarinas, Province of Cavite, Philippines

Mary Ann A. Gagante

Affiant

SUBSCRIBED AND SWORN to before me this _______________at ______________,

affiants exhibiting to me her National ID: 4203-2638-5109-8370 issued in Dasmariñas City
Cavite.

Doc. No. __________ Notary Public

Page No. __________
Book No. _________
Series of __________