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Republic of the Philippines}

Island Garden City of Samal}


x------------------x

JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS

We, JINNY B. MORIONES and JOHANNA R. LABOR, both of legal age,


married, Filipino citizens and residents of Island Garden City of Samal, Province of
Davao del Norte, under oath do hereby depose and say:

1. That we personally know ELHY STEVE DINAMPO who is the biological son
of ELIZABETH S. DINAMPO (mother), and was born on November 6,
1999 at Barangay Tagbay, Samal District, Island Garden City of
Samal;

2. That we further know for a fact that the birth of ELHY STEVE DINAMPO
was not registered with the Office of the Local Civil Registrar of the Island
Garden City of Samal for reason that the person entrusted with the
registration of his birth had failed to do so;

3. That we are not in anyway related in the above-named person by


consanguinity or affinity nor are we interested in the outcome of this
affidavit;

4. That we are executing this Affidavit in corroboration to our allegation


regarding the non-registration of the birth of ELHY STEVE DINAMPO within
the reglementary period and so with the desire to register the same with the
Office of the Local Civil Registrar of the Island Garden City of Samal, praying
for the issuance of the corresponding Certificate of Live Birth under “LATE
REGISTRATION OF BIRTH”.

IN WITNESS WHEREOF, we hereunto set our hand this ____ day of August,
2013, at Island Garden City of Samal, Province of Davao del Norte, Philippines.

JINNY B. MORIONES JOHANNA R. LABOR


Affiant Affiant
CEI: Barangay ID No. 112317041-1-82 CEI: BIR TIN 291-918-010
Issued by: LGU-IGACOS Issued by: BIR

SUBSCRIBED AND SWORN TO BEFORE ME, this ___ day of August, 2013, at
the Island Garden City of Samal, Province of Davao del Norte, Philippines, Affiants
personally appeared and exhibited to me their above-mentioned Identification Cards as
proof of their Competent Evidences of Identity.

Doc. No. __________;


Page No. __________;
Book No. __________;
Series of 2013.

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