Republic of the Philippines )

City of Malolos ) s.s.

Province of Bulacan )
x-----------------------------------x

JOINT AFFIDAVIT OF BIRTH

(FOR DELAYED REGISTRATION OF BIRTH)

We, ________________ and ________________, both of legal age,

Filipinos, all residents of ________________________________, after
having been sworn in accordance with law, do hereby depose and state that:

1. We know the facts and circumstances surrounding the

birth of the child name ________________ who was
born on ________________ at ________________ to
his/her biological parents ________________ and
________________, both being our personal
acquaintances/neighbors;

2. The said child was born outside of wedlock; (If married,

“The parents of the said child were validly married on
________________ at ________________ solemnized
by ________________ per Certificate of Marriage No.
________________);

3. The birth of the said child was attended by Dr.

________________, a duly licensed physician of the
same hospital; (If traditional hilot, “The birth of the said
child was attended by ________________, a Traditional
Hilot of ________________”)

4. The said child was immunized and baptized since one of

the requirements for baptism is the child’s birth
certificate which is still being applied for delayed
registration (omit if already immunized and baptized)

5. The birth certificate of the said child was not immediately

registered with the Office of City Civil Registrar,
________________, primarily because of the
inadvertence of the parents or failure of the person(s)
delegated to do so, hence, this Joint Affidavit;

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 6. The birth certificate of the said child is not registered
with any Office of the Local/Municipal/City Civil
Registrar.

7. We are executing this Joint Affidavit to attest the truth of

the foregoing facts of birth and to support the application
for delayed registration of the same with the Office of the
City Civil Registrar, ________________.

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

July 2019, in Malolos City, Bulacan, Philippines.

Juan Dela Cruz Juana Dela Cruz

Affiant Affiant
ID No. ___________ ID No. ___________
Valid until ________ Valid until ________

ATTESTATION

We, ______________ and ______________, of legal age, Filipino citizens, and

residents of Brgy. Bulihan, Malolos City, Bulacan, under oath, do hereby confirm the following
statements of the above-named affiant to be true and correct. We further state that we
personally know the affiant and the person subject to the application for delayed registration of
birth.

Juan Dela Cruz Juana Dela Cruz

Affiant Affiant
ID No. ___________ ID No. ___________
Valid until ________ Valid until ________

SUBSCRIBED AND SWORN to before me, this _____ day of July 2019 in
Malolos City Bulacan, Philippines.

Doc No. _____

Page No. _____
Book No. _____
Series of 2019

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