Republic of the Philippines )

Province of Kalinga ) S.S

City of Tabuk )

AFFIDAVIT OF PARENTS

We, __________________________________ and ________________________

both of legal ages, Filipino and residents of ___________________, City of Tabuk,
Kalinga after having been duly sworn according to law, depose and state:

1. That we are the biological parents of the following:

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

2. That the aforesaid child/ children were born out of wedlock. However at the
time of conception and birth of our child/ children, we did not have any legal
impediment to marry each other and we were already living as husband and
wife;

3. That the birth of our child/ children were not registered on time due to
negligence and inadvertence on our part;

4. That we are executing this affidavit to state the truth of the facts above stated
to the best of our personal knowledge and belie, and for any legal purposes it
may serve.

IN WITNESS WHEREOF, we hereunto set our hands this _____ day of August
2016 at City of Tabuk, Kalinga.

__________________________ _______________________
CTC No. __________________ CTC No. _______________
Issued on __________________ Issued on _______________
Issued at City of Tabuk, Kalinga Issued at City of Tabuk, Kalinga

SUBSCRIBED AND SWORN to be me this ________ day of _________

2016 at City of Tabuk, Kalinga.

Michelle B. Gayagay
Notary till Dec. 31, 2017
Roll No. 63190
IBP OR 1002707; 12- 15- 15
PTR 6317369; 1-4- 16
Tabuk City, Kalinga Province