Republic of the Philippines }

City of Davao
}s.s.
AFFIDAVIT of DELAYED REGISTRATION OF BIRTH
I, REYNALD PANDILI LOZADA, Filipino, of legal, age, single and a resident of
Purok 2A Dampa, Magtuod, Ma-a, Davao City after being sworn in accordance with
law, hereby depose and state, THAT:
1. I am the same person who caused the execution of this Affidavit for the
purpose of applying for a delayed registration of my birth out of town
before the Office of the Local Civil Registrar General of Davao City;
2. However, the National Statistics Office issued a Negative Certification of
Birth in my favor, proving that I am not duly registered before the Local
Civil Registrar General of Caraga, Davao Oriental and National Statistics
Office, respectively. Copy of which is herewith attached as Annex B, and
contained the following details and information:
i.
ii.
iii.
iv.
v.

NAME:
BIRTH DATE:
PLACE of BIRTH:
FATHER:
MOTHER:

REYNALD PANDILI LOZADA;

March 12, 1979;
Caraga, DAVAO ORIENTAL;
EDDIE LANZADERAS LOZADA; and
ABADISA PLAZA PANDILI

3. The delay of the registration of my birth was due to the fact that my
parents were not married and that I was sired out of wedlock;
4. I am executing this affidavit to attest to the truth of the foregoing facts
and for the purpose of supporting my application for a delayed registration
of my birth as it was not properly registered before the concerned
authorities in the Municipality of Caraga, Davao Oriental and for whatever
legal intent and purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
February, 2015, Davao City Philippines
REYNALD PANDILI LOZADA
Affiant
VIN 2402-1132C-C1279RPL10000
Issued by COMELEC Davao City
CORROBORATING

STATEMENT

WE, EMEGDIA JAMISOLA; married and EDITHA QUIBOD; married, both

Filipinos, of legal ages, and residents of Bucana, Davao City, Philippines, after having
been duly sworn in accordance with law, do hereby depose and say:
1. That we personally know the above named Affiant as the applicant for a
delayed registration of birth ;
2. That we declare that the above allegations are true and correct based on
our personal knowledge and belief;
3. That we execute the same to support his application for a delayed
registration of birth before the Office of the Local Civil Registrar General of
Davao City.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day

of February, 2015 in Davao City, Philippines.

EMEGDIA JAMISOLA
Affiant
SSS 09.198804.2

EDITHA QUIBOD
Affiant
SSS 09.18937757

SUBSCRIBED AND SWORN TO BEFORE ME, this ___ day of February, 2015,
Affiants exhibited to me their respective competent proofs of identity as shown above
and particularly acknowledges that they have understood the same and further
executing that the same is made of their voluntary and free act and deed.
WITNESS MY HAND AND SEAL on the day above-stated.

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2015.

Republic of the Philippines )

City of Davao
) s.s.
x ------------------------------------- x
JOINT-AFFIDAVIT of BIRTH

WE, EMEGDIA JAMISOLA; married and EDITHA QUIBOD; married,

both Filipinos, of legal ages, and residents of Bucana, Davao City, Philippines,
after having been duly sworn in accordance with law, do hereby depose and
say:
1. That we personally know the person of REYNALD

PANDILI
LOZADA, born on March 12, 1979 at Caraga, Davao Oriental, Philippines
to parents EDDIE LOZADA and ABADISA PANDILI;

2. That we can attest that he has no records of birth registered before

the Local Civil Registrar General of Caraga, Davao Oriental nor was
his birth duly registered in the Office of the National Statistics
Office;
3. That REYNALD PANDILI LOZADA intends to apply for a delayed
registration of birth with the Local Civil Registry of Davao City;
4. That we are not related by blood nor of affinity to the applicant for a
delayed registration of birth with the concerned agency of the
government;
5. That we are executing this Affidavit freely and voluntarily to attest
to the truth of the foregoing statements for the purpose of
supporting his documents and papers for the application of a
delayed registration of birth with the Office of the Civil Registry of
Davao City; to request the same Office to electronically transfer the
said registration if accepted to the Office of the National Statistics
Office for record purposes and for whatever any legal purpose this
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
______ day of February, 2015 in Davao City, Philippines.

EMEGDIA JAMISOLA
Affiant
SSS 09.198804.2

EDITHA QUIBOD
Affiant
SSS 09.18937757

SUBSCRIBED AND SWORN TO BEFORE ME, this ___ day of June,

2014, affiants exhibited to me their respective competent proof of identities
as shown above and particularly acknowledges that they have understood
the same and further executing that the same is made of their voluntary and
free act and deed.
WITNESS MY HAND AND SEAL on the day above-stated.
Doc No. _____;
Page No. _____;
Book No. _____;
Series of 2015.