Affidavit Of The Mother.docx

REPUBLIC OF THE PHILIPPINES) CITY OF BACOLOD ) X---------------------------------------X

AFFIDAVIT OF THE MOTHER

I, REBECCA ETANG SOBREMISANA, of legal age, Filipino, and a resident of Manihan, Barangay Bunga, Salvador Benedicto, Negros Occidental, Philippines, after having been duly sworn in accordance with the law, depose and say: That I am the mother of the illegitimate child named, SHANELLE SOBREMISANA REBATADO who was born at the Adventist Medical Center-Bacolod, Bacolod City on May 23, 2018; That the attendant to the delivery was EIREEN B. DE LEON, MD addressed at Adventist Medical Center – Bacolod, Bacolod City, Negros Occidental, Philippines. That the father of my child is JERALD LOBATON REBATADO who is a resident of Manihan, Barangay Bunga, Salvador Benedicto, Negros Occidental, Philippines. That the father of my child acknowledges her birth by accomplishing the affidavit of acknowledgment at the back page of the Certificate of Live Birth; That lately when I went to the Office of the City of Civil Registrar of Bacolod City to request for a copy of her birth certification, I was surprised to find out that my child’s birth was not registered within the prescribed period of thirty days; That when I verified from the attendant of his birth, I was informed that she failed to register the same because the certificate was not properly signed by us and we also failed to follow-up the attendant of the birth; I execute this affidavit to affirm the truth of the foregoing and to request the Civil Registrar of Bacolod City to register my birth late in accordance with the provision of Circular No. 90-4, so that I could secure an Official Copy which I was going to use in school. IN WITNESS WHEREOF, I set my hand on this affidavit this ______ day of _______________ at the City of Bacolod, Philippines.

______________________ Affiant

SUBSCRIBED AND SWORN to before me this ______ day of _____________ 20_____ at _______________________________, Negros Occidental, affiant exhibiting to me his __________________________ with number __________________ as valid proof of his identity.

NOTARY PUBLIC

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