Republic of the Philippines }

Province of Davao del Norte }s.s.

City of Panabo }

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

I, BERNADITA MACAN ALBACITE, of legal age, Filipino, single and a resident of

Batobato, San Isisdro, Davao Oriental, 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 my birth;

2. That I was born on January 7, 1961 at San Isidro, Davao Oriental;

3. That my parents are MODESTO TATOY ALBACITE and LUCIDA ANGCO MACAN;

4. That the reason for the delay in registering my birth was negligence and/or
inadvertence of my parents and the prevailing conditions then;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
support my application for the registration of my birth and the issuance of my
Certificate of Live Birth.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________ at

Panabo City, Davao del Norte, Philippines.

BERNADITA MACAN ALBACITE

Affiant
____ ID No. __________________

SUBSCRIBED AND SWORN to before me this ________________ at Panabo City, Davao

del Norte, Philippines.

Doc. No.: ___;

Page No.: ___;
Book No.: ___;
Series of 2018.