Republic of the Philippines}

Province of Camarines Sur}

Municipality of Goa }S.S

AFFIDAVIT OF GUARDIANSHIP

I, __________________________, of legal age, Filipino citizen, and with postal and residence
address at ___________________________ Philippines after having been duly sworn to in accordance
with law, hereby depose and say:

1. That I am the biological father and legal guardian of _______________________ who was
born on __________________ at __________________________ Goa, Camarines Sur;

2. That the above-mentioned child is under my custody since he was 2-year-old when his
biological mother left him under my custody;

3. Hence, as a legal guardian I undertake to cause the preparation of documents and application
for the delayed registration of birth of the above-mentioned child;

4. As such, I am executing this affidavit to attest to the veracity of the foregoing facts for the
delayed registration of birth of the above-mentioned child and for whatever legal intents and
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________________

in ___________________ Philippines

____________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________________, at

_________________ Goa, Camarines Sur.

Doc. No.______;
Page No.______;
Book No. XII;
Series of 2024.