REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS )S.S

MATAASNAKAHOY

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

(Re: Late Registration of Live Birth)

We, MILAGROS A. ESMEDILLA and LEONARDO E. ROXAS, both of legal

ages, Filipino citizens and residents of Brgy. Bayorbor Mataasnakahoy, Batangas, after
being duly sworn in accordance with law, do hereby depose and state:

That, we personally know RODOLFO LUMBERA DIMAYUGA who was born on

May 17, 1944, at Bayorbor Mataasnakahoy, Batangas

That, HE IS THE SON OF THE Spouses MA. SOLEDAD H. LUMBERA and

PEDRO TISBE DIMAYUGA;

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

That, the birth certificate of the said child is not registered with any Office of the
Local/Municipal/City Civil Registrar;

That, we are executing this affidavit freely and voluntarily to attest to the
foregoing narration of the facts of the birth of the person, and to support the application
for delayed registration of the same with the Office of the Municipal Civil Registrar, and
for whatever legal purposes and interest this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands on this ____ day of
September 2023, at Mataasnakahoy, Batangas.

MILAGROS A. ESMEDILLA LEONARDO E. ROXAS

Affiant Affiant

SUBSCRIBED AND SWORN to before me, on this ____ day of September

2023, at Mataasnakahoy, Batangas.

NOTARY PUBLIC

Doc. No. _____;

Page No._____;
Book No. _____;
Series of 2023.