REPUBLIC OF THE PHILIPPINES)

PROVINCE OF COTABATO : S.S.

MUNICIPALITY OF KABACAN )
X-------------------------------------------X

AFFIDAVIT

I, _______________________, of legal age, married, Filipino, and a resident

of ________________________, Philippines, after having been duly sworn to in
accordance with law depose and say:

That I am an applicant for the late registration of my birth;

That I was born on _____________________________;

That my parents are ___________________________;

That the facts of my birth were not duly registered with the Local Civil
Registry Office of Kabacan, Cotabato within the period required by law due to
inadvertence of my parents and not knowing the adverse consequence it
may bring about;

That I execute this affidavit to attest to the truth of the foregoing

statements and for any lawful purpose which it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this day of

_______________ at Kabacan, Cotabato, Philippines.

________________________
Affiant
_________________________________

CORROBORATION

WE, ______________________ and _________________________, both of legal

age, Filipinos, and residents of Kabacan, Cotabato, Philippines, after having
been duly sworn to in accordance with law depose and say:

That we personally declare that the above statements of

______________________ are true and correct to the best of our knowledge and
beliefs having known her.
 ________________________
Affiant
_________________________________

SUBSCRIBED AND SWORN to before me this day of _______________

at Kabacan, Cotabato, Philippines. Affiants having exhibited their proof of
identities as indicated below their names.