REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SOUTHERN LEYTE) Ss.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

(For Delayed Registration of Birth)

WE, GENALYN E. ESCABOSA and JOEY BERIDO ROLEGA, both Filipino

citizens, of legal age, married and residing in Union, Bontoc, Southern Leyte, having been sworn
in accordance with the law, hereby depose and state:

1. THAT we personally know JEREMIE ESPIRITU by reason of community and social

relations of long standing;

2. THAT we declare, confirm and affirm that to the best of our knowledge, he was born on
September 05, 2006 at Union, Bontoc, Southern Leyte to MERY R. ESPIRITU, a
resident of Union, Bontoc, Southern Leyte, Philippines;

3. THAT we know, however, that his facts of birth have not been registered with the Local
Civil Register of Bontoc, Southern Leyte and the Philippine Statistics Authority;

4. THAT we are not related to JEREMIE ESPIRITU either by consanguinity or affinity

nor do we have any pecuniary interest on this matter whatsoever;

5. THAT we are executing this affidavit to attest to the veracity of the foregoing stipulations
for purposes of recording and registering the facts of birth of JEREMIE ESPIRITU
with the LCR- Bontoc, Southern Leyte and the Philippine Statistics Authority, and for
whatever legal purpose this may serve best.

IN WITNESS WHEREOF, WE have hereunto set our hands this

_______________ at Bontoc, Southern Leyte, Philippines.

GENALYN E. ESCABOSA JOEY B. ROLEGA

Affiant Affiant
National ID: 3907-9471-2601-9574 Philhealth ID No. 13-202229066-
9
Bontoc So.Leyte /December 17, 2022 Bontoc, So. Leyte

SUBSCRIBED AND SWORN to before me, a notary public, on the date and place
abovementioned; affiants’ identities I have ascertained thru their respective government-issued
ID card as per data indicated below their names and that they are the same persons who
personally signed before me the foregoing Joint Affidavit of Two Disinterested Persons and
acknowledged that they executed the same.
.

Doc No. ____;

Page No. ____;
Book No. ____;
Series of 2024