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 Brgy. Cogon Pardo, Cebu City and Brgy. Inayawan, Cebu City; having been sworn in accordance with the law, hereby depose and state: 1. THAT we personally know ________________________, born last December 1, 2012, Cebu Puericulture Center and Maternity House, Inc., Cebu City, Cebu, to spouses: ____________________ and ____________________, residents of Cebu City, Philippines; 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, ______________________; THAT we further know, however, that _____________________ facts of birth have not been registered with the Local Civil Register, Cebu City and the National Statistics Office; 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 childs father from abroad to sign the affidavit of paternity beyond the reglementary period; THAT we are not related to ____________________either by consanguinity or affinity; 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- Cebu City and the National Statistics Office, and for whatever legal purpose this may serve best.

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IN WITNESS WHEREOF, I have hereunder affixed my signature on this affidavit of guardianship this 11th day of April 2013, in Cebu City, Philippines.

____________________ Affiant TIN: ____________________

____________________ Affiant 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 2013.