Free Legal Form

Affidavit for Delayed Registration of Birth

For registering a birth more than 30 days after it happened. The mother, father or guardian signs it, or the person themselves if they are already 18 or older.

You

Your Full Name (the One Signing)

Your AgeIn years, for example 34.

Civil Status

Home Address

You Are

The Birth

Full Name of the Person Whose Birth Is Being RegisteredIf it is your own birth, type your own name.

Sex of the Registrant

Date of BirthFor example, 14 August 2009.

Place of BirthHouse, hospital or clinic, barangay, city or municipality and province. For example, at home in Barangay Poblacion, Rosario, Batangas.

Who Attended the Birth, If KnownFor example, Dr. Ana Reyes, a midwife, or a hilot named Rosa Cruz. Leave it empty to skip.

Citizenship of the Registrant

Parents

Mother's Maiden Name

Father's NameIf the parents were not married, include the father only if he acknowledges the child.

At the Time of the Birth, the Parents

Date and Place of the Parents' Marriage, If MarriedFor example, 2 June 2005 at Tanauan City, Batangas. Leave it empty if they were not married.

The Delay

Why the Birth Was Not Registered on TimeIn plain words. For example: the birth took place at home, far from the town hall, and my parents did not know it had to be registered.

If the Registrant Is Married, the Spouse's NameLeave it empty if not married.

City or Municipality Where the Birth Will Be RegisteredUsually where the birth took place.

Where

City or Municipality Where It Will Be Notarized

Your Government IDFor example, PhilSys ID No. 1234-5678-9012-3456.

What you type is kept on this device only, so you can come back and finish later. Nothing is sent anywhere. Press Clear to erase it, especially on a shared phone or computer.

REPUBLIC OF THE PHILIPPINES )
city or municipality ) S.S.

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

I, affiant's full name, age years old, Filipino, civil status, and residing at home address, after having been duly sworn in accordance with law, hereby depose and state that:

I am relationship to the registrant, and I am applying for the delayed registration of the birth of registrant's full name, sex, who was born on date of birth at place of birth;
The citizenship of the registrant is citizenship;
The registrant's mother is mother's maiden name. At the time of the birth, the registrant's parents married or not married;
The birth was not registered with the Local Civil Registrar of city or municipality within thirty (30) days after it took place, nor, to the best of my knowledge, with any other civil registrar, because reason for the delay;
I am executing this affidavit to attest to the truth of the foregoing and to support the delayed registration of the birth of registrant's full name, and for whatever other lawful purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ______________ 20___ at city or municipality, Philippines.

affiant's full name
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______________ 20___ at city or municipality, Philippines, affiant exhibiting to me ID type and number as competent evidence of identity.

Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 20___.

NOTARY PUBLIC

Before You Print

Not legal advice. This is a general form. For your own situation, consult a lawyer, especially if your case is unusual or a lot of money is involved.
You will swear before the notary that it is true, then sign (this is called a jurat).
Do not sign it yet. You sign in front of the notary, with a valid government ID.
The Certificate of Live Birth used for late registration usually has this affidavit printed on its back. Ask the Local Civil Registrar whether it accepts a separate affidavit, or wants the one on the form.
The civil registrar will also ask for other papers, usually at least two documents showing the facts of birth (such as a Baptismal Certificate or school records), a PSA certificate saying it has no record of the birth (a negative certification), and an Affidavit of Two Disinterested Persons. See the guide Late registration of birth.
If the parents were not married to each other and the child will use the father's surname, the father's written admission that the child is his, and an Affidavit to Use the Surname of the Father, are separate documents.
Only sign it if it is true. Swearing to something you know is false is perjury, a crime under the Revised Penal Code.

What notarizing it usually costs →

For the steps around this document, see the guide Late birth registration.

Affidavit for Delayed Registration of Birth

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

Before You Print

Related

More Forms Like This