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 __________________________
and __________________________; having been sworn in accordance with the law, hereby
depose and state:

1. THAT we personally know __________________________, born on

__________________________, at __________________________ to spouses:
__________________________, 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, Cebu City and the
National Statistics Office;

4. THAT the reason for the delayed registration of the facts of birth of
__________________________was because of __________________________to wait for
the arrival of the childs 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- Cebu City and the National Statistics
Office, and for whatever legal purpose this may serve best.

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

of Two Disinterested Persons this __________________________, in Cebu City,
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 2017.