Republic of the Philippines)

Province of Cebu )
Municipality of Liloan )S.S.

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

I, JUANA MAGLASANG NOYA, of legal age, single, Filipino and with residence and
postal address at Brgy. Sta. Cruz, Liloan, Cebu, Philippines after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I am the applicant for the delayed registration of the birth of my son KLENT
JAYRON NOYA;

2. That he was born on April 22, 2017, at Eversley Child Sanitarium, Jagobiao,
Mandaue City, Cebu, Philippines;

3. That I and his father, LITO BONIEL ELICANO are not yet legally married;

4. That his biological father LITO BONIEL ELICANO is willing to execute an

affidavit of recognition of paternity of his child KLENT JAYRON NOYA;

5. That the reason for the delay in registering my son’s birth was due to the fact that
the hospital and the City Health Office is far from our place of residence and lack
of time;

6. That a copy of his birth certificate is needed for the purpose of late registration
and to have a record in the Philippine Statistics Office.

7. That I execute this affidavit to attest to the truth of foregoing facts.

JUANA MAGLASANG NOYA

Affiant

SUBSCRIBED AND SWORN to before me this 12 th day of January 2019, in

Liloan, Cebu, Philippines. Affiant exhibiting to me her Voter’s ID with VIN 2227-0108A-
H1980JMN20001-1 issued by the COMELEC Office of Liloan, Cebu.

Doc No._____;
Page No. _____;
Book No._____;
Series of 2019.