REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU … … … … … … ...)Ss.

AFFIDAVIT OF
TWO DISINTERESTED PERSONS
(For Delayed Registration of Birth)

WE, ___________________________ and ___________________________ , both

Filipino citizens, of legal age, single, and respectively residing in
___________________________ ; having been sworn in accordance with the law, hereby
depose and state:

1. THAT we personally know ___________________________ , born last

___________________________ at ___________________________ to spouses:
___________________________ and ___________________________ , residents of
___________________________ , Philippines;

2. THAT we know that the minor was attended at birth by

___________________________ , resident of Cebu City, and that her parents are
not married but she was acknowledged by his father,
___________________________;

3. THAT we further know, however, that ___________________________ facts of birth

have not been registered with the Local Civil Register,
___________________________ and the Philippine Statistics Authority;

4. THAT the reason for the delayed registration of the facts of birth of
___________________________ was because of ___________________________
decision (mother) to wait for the arrival of the child’s father from abroad to sign
the affidavit of paternity beyond the reglementary period;

5. THAT we are not related to ___________________________ either by consanguinity

or affinity;

6. THAT we are executing this affidavit to attest to the veracity of the foregoing
stipulations for purposes recording and registering the facts of birth of
___________________________ with the LCR- ___________________________ and the
Philippine Statistics Authority and for whatever legal purpose this may serve
best.

IN WITNESS WHEREOF, I have hereunder affixed my signature on this affidavit

of guardianship this ___________________________, in ___________________________,
Philippines.

___________________________ ___________________________
Affiant Affiant
TIN: ___________________________ TIN: ___________________________

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.

Doc No. _____;

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