Republic of the Philippines )

__________.) SS.
x----------------------------x
JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS
(FOR DELAYED REGISTRATION OF BIRTH)

WE, ___________________ and ___________________, both of legal age,

Filipinos and all residents of ________________________________, after having been
duly sworn to in accordance with law, do hereby depose and state that:
1. We know the facts and circumstances surrounding the birth of the child
named _________________________ who was born on _________ at
_________________________________ to his/her biological parents
____________________ and ________________________, both being our
personal acquaintances/neighbors;
2. The said child was born outside of wedlock; (If married, The parents of
the
said
child
were
validly
married
on
_______________
at
________________________ solemnized by ______________________ per
Certificate of Marriage No. _______________)
3. The birth of the said child was attended by Dr. __________________, a
duly licensed physician of the same hospital; (If traditional hilot, The birth of
the said child was attended by _______________, a Traditional Hilot of
__________________________)
4. The said child was immunized and (but not yet) baptized since one of the
requirements for baptism is the childs birth certificate which is still being
applied for delayed registration (omit if already immunized and baptized);
5. The birth certificate of the said child was not immediately registered with
the Office of City Civil Registrar, _______________, primarily because of the
inadvertence of the parents or failure of the person(s) delegated to do so,
hence, this Joint Affidavit;
6. The birth certificate of the said child is not registered with any Office of
the Local/Municipal/City Civil Registrar;
7. We are executing this Joint Affidavit to attest to the truth of the foregoing
facts of birth and to support the application for delayed registration of the same
with the Office of the City Civil Registrar, ________________.
IN WITNESS WHEREOF, we have hereunto set our hands this _____________
at _______________________.

_________________
Affiant
ID No. ___________
Valid until __________
SUBSCRIBED AND
_________________.

Doc. :________________;
Page :________________;
Book :________________;
Series of 2016.

_________________
Affiant
ID No. ___________
Valid until __________
SWORN

to

before

me

this

_______________

at

NOTARY PUBLIC
WITNESS
Affiant
DSWD 4Ps Beneficiary ID
No. 1602020
Issued at Butuan City