Republic of the Philippines )

City of Dipolog ) S.S

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

AFFIDAVIT

I, ESTERLINA REGENCIA BOER , Filipino, of legal age, married and a resident

of 687, Gen. Luna St., Dipolog City, after having duly sworn in accordance with law, do
hereby depose and state that:

1. That I am the daughter of EMELIO MALIGRO-REGENCIA who was born on

July 22, 1932 in Punta, Dipolog City. Photocopy of Baptismal Certificate is
hereto attached and Marked as Annex “A”;

2. That I requested an authenticated Certificate of Live Birth of my father on

February 21, 2019 in the office of Philippine Statistic Authority but
unfortunately he was not registered. Photocopy of the document from
Philippine Statistic Authority (PSA) is hereto attached and marked as Annex
“B”;

3. That I intend to apply for a delayed registration of birth of my father as he

can not be able to walk due to old age;

4. That I am executing this affidavit to the best of my knowledge and belief to

substantiate the Birth Certificate of my father EMELIO MALIGRO-
REGENCIA which could not be obtained from the Office of the Philippine
Statistic Authority (PSA) due to the fact that after a thorough and diligent
search made on the existing records of births kept on file in this Office, the
name EMELIO MALIGRO-REGENCIA does not appear therein;

IN WITNESS WHEREOF, I have hereunto affixed our hands this___________ of

March 2019 at Dipolog City, Philippines.

ESTERLINA REGENCIA BOER

Affiant
CTC No. 21532908

SUBSCRIBE AND SWORN to before me this ___________ of March 2019 at Dipolog

City, Philippines. Affiant is known to me and to me known to be the same person
executing this foregoing instrument.

Doc. No.___
Page No.___
Book No. II
Series of 2019
Republic of the Philippines )
City of Dipolog ) S.S
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AFFIDAVIT OF LOSS

I, FREDERICK S. CALOG, of legal age, Filipino, married and a resident of

Barangay Alvinda, Mutia, Zamboanga del Norte, after having duly sworn in accordance
with law, do hereby depose and state that:

1. That I am a holder of an Official Receipt from a purchase of a chainsaw in

Oroquieta City in the year 2017 which is more particularly described as
follows:
BRAND SERIAL MACHINE NO.

ZERO70 STEEL S178200084

2. That the said document while in my possession was misplaced and could no
longer ne located inspite of exerting efforts of locating them;

3. That I am executing this affidavit to attest the truth of the foregoing and for
whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, we have hereunto affixed our hands this____ day of

_______________ at ________________.

FREDERICK S. CALOG
Affiant
Philhealth ID 16-050166521-2

SUBSCRIBE AND SWORN TO before me this August 31, 2018 at Dipolog City.

Doc. No.___
Page No.___
Book No.___
Series of 2018.