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    Affidavit of Delayed Registration of Birth Sample

    REPUBLIC OF THE PHILIPPINES)
    CITY OF MAKATI                      ) S.S.
    x-------------------------------------x
      

    AFFIDAVIT OF DELAYED 
    REGISTRATION OF BIRTH


             I, MARIA B. DELA CRUZ, of legal age, Filipino, single and a resident of 6789 Washington Street, Pio del Pilar, Makati City, after having been duly sworn to in accordance with law, depose and state:

    1. That I am the applicant for the delayed registration of birth of my son Pedro Dela Cruz;

    2. That he was born in Davao City on October 25, 2012;

    3. That I was delayed in registering his birth for the reason that _______________________________________________________ .

    4. That  I am executing this affidavit to attest to the truth and veracity of the foregoing facts and and in compliance with the requirements of the Philippines Civil Registrar.

             IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of September 2013 in Makati City, Metro Manila, Philippines.
              



    MARIA B. DELA CRUZ
    Affiant

        SUBCRIBED AND SWORN TO before me this 6th day of September 2013 in Makati City, Metro Manila, Philippines, affiant exhibiting to me her Philippine Passport No. 123456 issued in Manila on January 12, 2012 and valid until January 12, 2017.

    Doc. No. _____;
    Page No. _____;
    Book No. _____;
    Series of 2013. 

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