REPUBLIC OF THE PHILIPPINES)

PROVINCE OF DAVAO DEL SUR: S.S.

CITY OF DIGOS
)
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AFFIDAVIT OF
TWO DISINTERESTED PERSONS
WE, PIOLO PASCUAL and JESSIE MENDIOLA, both
Filipino citizens, of legal age, single, and respectively
residing in Digos City, having been sworn in accordance with
the law, hereby depose and state:
1. That we personally know Maria Therese Leonora,
born last October 1, 2016, in Digos City, to: June Leonora
and Jane Uy, residents of Digos City, Philippines;
2. That we know that the minor was attended at birth by
Joan Noble, resident of Digos City, and that her parents are
not married but she was acknowledged by his father, June
Leonora;
3. That we further know, however, that Maria Therese
Leonoras facts of birth have not been registered with the
Local Civil Register, Digos City and the National Statistics
Office;
4. That the reason for the delayed registration of the
facts of birth of Maria Therese Leonora was because of jJane
Uys decision (mother) to wait for the arrival of the childs
father from abroad to sign the affidavit of paternity beyond
the reglementary period;
5. That we are not related to Maria Therese Leonora
either by consanguinity or affinity;
6. That this affidavit was executed to attest to the truth
of the foregoing facts and for whatever legal purpose this
may served.
IN WITNESS WHEREOF, we have hereunto set our hands this
9th day of January 2017 at Digos City, Philippines.

PIOLO PASCUAL
Affiant
ID No. 11111111

JESSIE MENDIOLA
Affiant
ID No. 222222222

SUBSCRIBED AND SWORN TO before me this 9th of

January 2017 at Digos City, Philippines.
Doc. No.
Page No.
Book No.
Series of

05;
01;
I;
2017.

ROXANNE Z. JURIAL
Notary Public
Until December 31, 2017
PTR No. 11111
TIN
222222
IBP No. 33333