Republic of the Philippines )

Caloocan City ) S.S.

AFFIDAVIT OF LATE REGISTRATION OF BIRTH

I, MARILOU LUMBAN REGALADO of legal age, married and with residence

and postal address at 55-E Tirad Pass st., Bagong Barrio, Caloocan City
After having duly sworn to in accordance with law, do hereby depose and say:

1. That I am the applicant for the delayed registration of my birth;

2. That I was born on December 21, 1968 at Reina Mercedes, Province of Isabela,
Philippines from spouses Catalino Canceran Lumaban and Josefa Calimag
Patriarca;

3. When I was at my tender age, I was using MARILOU PATRIARCA LUMABAN

both in my personal and business transactions;

4. That I got married to Federico C. Regalado on December 28, 1995 - Word of

Hope, Quezon City and bore him three children namely: Ruth Syvill Joyce L.
Regalado - 20 yrs old, Hannah Kristel L Regalado – 16 years old, and Psalm
Gabriel L Regalado – 14 years old;

5. That I am now using MARILOU LUMABAN REGALADO in all my present

undertakings whether private or business transactions;

6. That the reason for the delay in registering my birth was due to the fact that my
birth record was among the records archived in the Local Civil Registry of Reina
Mercedes, Isabela that was destroyed and the same could no longer be produced;

7. That I am executing this affidavit to attest to the truth of the foregoing instrument
and for any legal purposes and intent this may serve.

IN WITNESS WHERE OF I have hereunto set my hand this ____day of

______2019 in Caloocan City.

MARILOU LUMBAN REGALADO

Affiant
ID No.______________________
Issued on____________________
Issued at_____________________

SUBSCRIBED AND SWORN to before me this _______ day of _________,

2019, at the City of ______________, Philippines, the affiants exhibiting to me her
Government issued IDs written below her name.

Doc. No. ________

Page No. ________
Book No. ________
Series of 2019. NOTARY PUBLIC