REPUBLIC OF THE PHILIPPINES)

BIAN, LAGUNA) s.s.

X__________________________________X

Affidavit of Late Registration

I, CYRINE MAE V. ESMIRO, of legal age, single, Filipino
and a resident of Phase 3, Blk. 25, Lot 6, Timbao, Bian, Laguna
Philippines, after having been duly sworn to in accordance with
law hereby depose and say:
THAT I am the mother of the minor, CYRA MAE E.
LORICA, born on April 23, 2011, who was conceived and born
out of marriage;
THAT the birth of my daughter CYRA MAE E. LORICA is
yet to be registered with the Local Civil Registry;
THAT the father of my child is GIOVANNI Q. LORICA, who
is willing and able to acknowledge our daughter as evidenced by
the Affidavit of Acknowledgement of Paternity. A faithful
machine reproduction of the Affidavit of Acknowledgement of
Paternity is hereby attached as Annex A;
THAT pursuant to this acknowledgement, I can therefore
register the birth of my child CYRA MAE E. LORICA with the
Local Civil Registry of Bian City where she was born;
THAT the reason for the non-registration of the birth
certificate is due to financial constraint and lack of time.
THAT I am executing this Affidavit to attest to the
truthfulness and veracity of the foregoing statements.
FURTHER AFFIANT SAYETH NONE.
IN WITNESS WHEREOF, I have hereunto affixed my
signature this _________of ________ 2015 in________________
Philippines.
Cyrine Mae V. Esmiro
(Affiant)
SUBSCRIBED AND SWORN to before me this ___th day of
_______ at the ___________. I hereby certify that I personally
examined the affiant and that I am satisfied that she voluntarily
executed and understood her affidavit.

NAME
Cyrine Mae V. Esmiro
_________
Doc. No. .........:
Page No. .........;
Book No. .........;
Series of 2015.

CTC NO.
________

DATE
__________

PLACE