Republic of the Philippines)

City of Cebu…………….....)S.S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

I, CLARISSE ROSIEL O. ZOSA, Filipino citizen, of legal age, and with residence address at

Block 2 Lot 1 CKL Homes Subdivision, Brgy. Agus, Lapu-Lapu City and I, EGOR JOSE D.

BADAYOS, Filipino citizen, of legal age, and with residence address at 18- Pelaez Extension,

Cebu City after having duly sworn in accordance with law, hereby depose and state: THAT –

1. We know Jerome J. Fortunato and Irish Marie B. Villasin as the parents of the child

Chelsea V. Fortunato and have known them since February 2009;

2. We know their child, Chelsea V. Fortunato, who have born on August 14, 2014 in

Visayas Community Medical Center, Osmena Blvd., Cebu City;

3. The above-named child have been registered late because her father was also been

confined for measles at the same date and in the same hospital and the family has been

busy in looking for means to pay the hospital bills of both of them;

4. We are not related by consanguinity or affinity to the child’s parents;

5. We are executing this affidavit to attest to the truth and veracity of the foregoing facts

and in compliance with the requirements of the Philippine Civil Registrar.

FURTHER AFFIANTS SAYETH NAUGHT.

CLARISSE ROSIEL O. ZOSA EGOR JOSE D. BADAYOS

Affiant Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _____________ in Cebu City,

Philippines after exhibiting their Identification Cards/ Community Tax Certificate.

Doc No. ______

Page No. ______

Book No. ______

Series of 2014.

NOTARY PUBLIC