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Affidavit of Late Registration

Angelica Mariano Agustin is applying for the delayed registration of her son Mark Angelo Agustin Domingo's birth, which occurred on April 18, 2023, at Cagayan Valley Medical Center. The registration was delayed due to the loss of required documents, and the birth was not recorded in the local civil registry or the Philippine Statistics Office. This affidavit is executed to attest to the truth of these facts and comply with civil registry requirements.

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Patricia Chan

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0% found this document useful (0 votes)

21 views2 pages

Affidavit of Late Registration

Uploaded by

Patricia Chan

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Download as DOCX, PDF, TXT or read online on Scribd

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Republic of the Philippines }

Province of Cagayan } S.S.

City of Tuguegarao }
x-------------------------------------x

AFFIDAVIT OF DELAYED
REGISTRATION OF BIRTH

I, ANGELICA MARIANO AGUSTIN, Filipino, single and a resident of

Barangay Larion Bajo, Tuguegarao City, Cagayan, after having been duly
sworn to in accordance with law, depose and state that:

1. I am the applicant for the delayed registration of birth of my

son Mark Angelo Agustin Domingo;

2. He was born in Cagayan Valley Medical Center, Tuguegarao City

on April 18, 2023;

3. His father, Bong Dela Cruz Domingo recognizes and acknowledges

Mark Angelo Agustin Domingo as his son;

4. I was delayed in registering his birth for the reason that the
required documents to be submitted for the said registration were
lost;

5. The facts of his birth were not recorded neither in the local civil
registry nor the Philippine Statistics Office as I inadvertently failed
to register the same within the reglementary period;

6. I am executing this Affidavit to attest to the truth and veracity of

the foregoing facts and in compliance with the requirements of the
Philippines Civil Registry, particularly the
Tuguegarao City Civil Registry Office.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day

of June 2024 in Tuguegarao City, Cagayan.

ANGELICA MARIANO AGUSTIN

Affiant

SUBCRIBED AND SWORN TO before me this 10th day of June

2024 in Tuguegarao City, Cagayan, Affiant exhibiting to me the above-
stated proof of identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2024.

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Affidavit of Late Registration

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Affidavit of Late Registration

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Republic of the Philippines }

Province of Cagayan } S.S.

I, ANGELICA MARIANO AGUSTIN, Filipino, single and a resident of

1. I am the applicant for the delayed registration of birth of my

2. He was born in Cagayan Valley Medical Center, Tuguegarao City

3. His father, Bong Dela Cruz Domingo recognizes and acknowledges

6. I am executing this Affidavit to attest to the truth and veracity of

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day

ANGELICA MARIANO AGUSTIN

SUBCRIBED AND SWORN TO before me this 10th day of June

Doc. No. _____;

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