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    Affidavit For Supplemental Report

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    LCR CATMON
    The affidavit requests to supplement an individual's certificate of live birth by providing omitted information such as place of birth, sex, and names. It states that the original certificate was sent to the PSA and certain details were missing due to parental negligence. The affiant requests authorities to add this missing data.

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    © All Rights Reserved
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    Affidavit For Supplemental Report

    Uploaded by

    LCR CATMON
    6 views1 page
    The affidavit requests to supplement an individual's certificate of live birth by providing omitted information such as place of birth, sex, and names. It states that the original certificate was sent to the PSA and certain details were missing due to parental negligence. The affiant requests authorities to add this missing data.

    Original Title

    AFFIDAVIT FOR SUPPLEMENTAL REPORT

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    © © All Rights Reserved

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    The affidavit requests to supplement an individual's certificate of live birth by providing omitted information such as place of birth, sex, and names. It states that the original certificate was sent to the PSA and certain details were missing due to parental negligence. The affiant requests authorities to add this missing data.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    6 views1 page

    Affidavit For Supplemental Report

    Uploaded by

    LCR CATMON
    The affidavit requests to supplement an individual's certificate of live birth by providing omitted information such as place of birth, sex, and names. It states that the original certificate was sent to the PSA and certain details were missing due to parental negligence. The affiant requests authorities to add this missing data.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    REPUBLIC OF THE PHILIPPINES )

    PROVINCE OF CEBU ) S.S. Registry No.___________


    CATMON ) Date:_________________

    AFFIDAVIT FOR SUPPLEMENTAL REPORT

    I, RICHE GURREA LOCSIN, Filipino, of legal age, (married/single/divorced/widow/widower), with


    residence and postal address at Polog, Consolacion , Cebu, after having been duly sworn to in accordance with law, do
    hereby depose and say that:

    1. I am an applicant for the processing of the Supplemental Report of


    a) my Certificate of Live Birth registered in __________________on________________;
    b) the of Live Birth of _________________________________ registered in
    Catmon Cebu on_____________________;

    2. The original copy of my/his/her Certificate of Live Birth was forwarded to Philippine Statisrics
    Authority (PSA);

    3. When a copy of my/his/her Certificate of Live Birth was secured from ______PSA_____Local Civil
    Registry Office of ________________, it was discovered that there is no entry under the following
    Item/s:

    Geographical Location: Place of Birth:


    Province :______________ Province:___________
    City/Municipality: ______________ City/Municipality:_____________

    Child’s Sex:______ Child’s First/Middle/Last Name:_______________

    Child’s Type/Order of Birth:_____________________

    Child’s/Mother’s/Father’s Nationality/Citizenship: ____________________

    4. There was a failure to supply the said item/s due to negligence of parents to supply the said entry on
    given time;

    5. The entries to be indicated therein should be the following:

    Geographical Location: Place of Birth:


    Province :______________ Province:___________
    City/Municipality: ______________ City/Municipality:_____________

    Child’s Sex:______ Child’s First/Middle/Last Name:_______________

    Child’s Type/Order of Birth:_____________________

    Child’s/Mother’s/Father’s Nationality/Citizenship: ____________________

    6. I am requesting the concerned authorities to supply the omitted information in my/his/her Certificate of
    Live Birth; and

    7. This Affidavit for Supplemental Report is voluntarily executed in order to attest to the truthfulness of the
    Foregoing statements for all legal intents and purpose.

    WITNESS WHEREOF, I am affixing my signature this ____day of ________in Catmon, Cebu,


    Philippines.

    _______________________________
    Signature Over Printed Name of Affiant

    SUBSCRIBED AND SWORN to before me this _______day of ______________at Catmon, Cebu,


    Philippines. Affiant exhibited to me his/her valid issued ID with No._____________________and issued on
    ___________________at_____________________.

    Doc. No. _______________;


    Page No. _______________; JECILLE ANN A. PEREZ
    Book No. _______________; OIC-LOCAL CIVIL REGISTRAR
    Series of _______________

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