Republic of the Philippines )

Xxxxxxxxxxxxx City ) S.S.

AFFIDAVIT OF DELAYED REGISTRATION OF MARRIAGE

I,JAYCEL xxxxxxxxxxx, of legal age, married, and a resident of xxxxxxxxxxxx City

after having duly sworn in accordance with law, do hereby depose and say that:

1. I am the applicant for the delayed registration of my marriage with

xxxxxxxxxxxxxxxxx, a citizen and resident of xxxxxxxxxxxxxxx.

2. The said marriage took place on xxxxxxxxxxx in the Ministry of Foreign Affairs of the
Kingdom of Thailand.

3. At the time of our marriage, I was a Filipino Citizen and my spouse was citizen of U.S.A,
and we have retained such citizenship.

4. The reason for the delay in the registration of our marriage was due to the numerous
errors/corrections in our Report of Marriage Form that I had to correct multiple times,
thus the registration of our marriage got delayed.

5. The said marriage has not been previously registered with the Philippine Consulate or
the PSA.

IN WITNESS WHEREOF, we have hereunto set my hand this xxxxxxxxxxx, xxxxxxxxxxxx

City, Philippines

xxxxxxxxxxxxxxxxxxxxxx
Affiant
ID No. _______________________

SUBSCRIBED AND SWORN TO before me this xxxxxxxxxxxxxxxxxx City Philippines

Doc No.
Page No.
Book No.
Series of 2023