(DFA-OCA-CRD-06 / REV.01 / 24 APRIL 2018)

FOR THOSE REPORTING ONE YEAR AFTER THEIR MARRIAGE, KINDLY ACCOMPLISH THE AFFIDAVIT BELOW:

AFFIDAVIT FOR DELAYED REGISTRATION OF MARRIAGE

WE/I, ______________________________________________________ both of legal age,

and with residence and postal address at ___________________________

___________________________________________________________________________,

after having been duly sworn to in accordance with law, do hereby depose and say:

1. That We/I are/am the applicant for the delayed registration of marriage of

______________________________ and _______________________________.

2. That We/ I were married on __________________________________________

at ________________________________________________________;

3. That at the time of Marriage I / he / she/We am/is/was/were a Filipino Citizen/s

and

4. That the reason for the delay in registering our/my marriage was due to

__________________________________________________________________;

_________________________ _________________________ Signature over Printed Name Signature over Printed Name Husband Wife

SUBSCRIBED AND SWORN to before me this _____________________ day of

______________________, 20 __ in the City and County of Los Angeles, California, U.S.A.

NOTARY PUBLIC