AFFIDAVIT OF LATE REGISTRATION OF BIRTH

We, ________________________________ and ________________________________,

both of legal age, married, Filipino Citizens, and presently residing at
________________________________after having been sworn in accordance with law,
hereby depose and state that:
1. We are the parents of, and the applicants for the delayed registration of the
birth of our child, ________________________________, who was born on
________________________________at ________________________________;
2. We
were
married
________________________________;
marriage;

on
and

________________________________at
our child was born during such

3. The reason for the delay in registering our sons birth was a family
emergency, particularly a serious illness of affiants mother, which prompted
us to rush home to Manila, Philippines soon after our childs birth.
4. We are executing this affidavit to attest to the truth and veracity of the
foregoing facts and in compliance with the requirements of the Philippine
Civil Registrar and the Philippine Consulate.
IN
WITNESS
WHEREOF,
we
hereby
_____________________ at New York, NY, U.S.A.
____________________________________

sign

this

Affidavit

this

____________________________________

EMBASSY OF THE PHILIPPINES)

NEW YORK, NY, U.S.A
) S.S.
SUBSCRIBED AND SWORN to before me this ___________________________ at
New York, NY, U.S.A.