‘Municipal Fown No. 102 (Ravieod January 2007) CERTIFICATE OF LIVE BIRTH Tio be accomalshed i auadruplcaie using bk ini] Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL |219. GERTIFIGATION OF ATTENDANT AT BIRTH (Physician, Huse, Midwife, Tedtonel Birt AlonsentTtot te) | hereby cotify that | attended the birt ofthe child who was born ave a Registy No Province —_ cegisity City/Municipality 7 NAME or sae Tam [2 SEXiMale/Femaie) =| 9. DATECOF (ayy (Menth) (veor) c BIRTH TRACE OF [Ears gp EIR Prone 1 Bace Err earnnaneain Piannesy il Dl nREOr eR ‘BF MULTIPLE BIRTH CHILD WAS | fo. DIRTHORDER owvvasmy [RWEIGHTATERTR (Silo Pwn Tole) {er Seca. Tn. te) Some | FRSA ERS __ orams "7 mabe est ‘cay ast Nane Meare cmamaaines: ——— 14 [708-Tenterivr of | 106, ot con win [105 Ne sf etn soe, OCCUPATION 2. AGE ate orn FB Hasta | ia wauirae en |" Sea Sd gu yu) | |____ yl — Rta ResIeNcE (House No. Si, Barenpay) (iyiNankcpatyy (Provines) (Cava) |e Nan Feo 0 Tay A | ip cirizensriP 16 RELIGIOWRELIGIOUS SECT FTCSCURATION {8 Ast who we alte T | compa yoo) H 5 10, RESIDENCE (House No., St, Barangay) (CiliyAdanicspality) (Province) (Country) MARRIAGE OF PARENTS «i rotmanied. acemplah Adar o AinentodgemonAgrision of Pterty ote set) fzos-DATE (Monthy (ay) (Year) «20R.PLACE —(Cty/ Muricpalty) (Province) J? ta ATTENDANT - a - _ 1 Physcion 2 Nurse ___3. Midwi___ ot (Tracona Bir Aencant) _ § Others (Spey) ‘amvpry on the date of bitn specited above. Sieistire Addrose Nome in Pat — - “Tile oF Positor bate. z 22. CERTIFICATION OF INFORMANT Tinereby cerity ta all information supplied are tue and ] 25 PREPARED BY Date. 2t RECEIVED BY Mame in Print — “Tie or Peston cconect to my own knowledge and boli. Signature Signature —— Nama in Print - (ei Relationship tothe Crile “rise a Addr | pete REMARKS/ANNOTATIONS (For LGROIOCRG Use Only) ae 25 REGISTERED BY THE GL REGISTRAR Signature Name in Print ‘Tve or Pestion [70 BE FILLED-UP AT THE OFFICE OF THE CIVIL REGISTRAR, 6 6 7 0AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION OF PATERNITY For bit Seow 3 August 088) (For bites on or ater 2 Aquat 1088) owe, of legal age, amvare the natural mother and/or father of bor on at __ and ‘ who was | am / We are executing this affidavit to attest to the truthfulness of the foregcing etatements and for purposes of ‘acknowledging myiour child. ‘Cianatare Over Printed Name of Father) Tignatare Over Printed Narse of Mather) SUBSCRIBED AND SWORN to beto and —___» who exhibited to me (nismer) Community Tax Cort. No. Se ‘Signalure ef the Administering Omicer Nore in Pret AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH (10 be accomplished by the hospice administrator, father, mother, or guardian or tha patton himsol! #8 years old or over.) 1 a of legal age. single/marrieditivorced/widew/widewer, with residence and postal address at ‘after having been duly eworn in accordance with law, do hereby depose and say: ‘That | arn the applicant for the delayed registration of ) bitin on ] te bith ot ve wae Thot he/she was aitended at birth by That | arvnershe Is 2 cizen of ‘That mymhisiher parents wore [| mariied on ‘rot martied but Une/she was acknowledgedinot acknomedged by myihismer father whose name is . That the reason for the dalay in registering my/his/her birth wae (For the applicant only) That | am martied to (it the applicant is other than the document owner) That lam the of the said person. ‘That | am executing this affidavit to attost to the truthfulness of the foregoing statements forall legal intents and purposes. In truth wheraof, | have affixed my signature below thi day of at SUBSCRIBED AND SWORN ‘0 before me this _ « Philppines, atfiant who exhibited to me his Community Tax Gert. sued on at