FA FORM NO. 40
(Est. April 1947)

Foreign Service of the Philippines

REPORT OF BIRTH

Child Born Abroad of Philippine Parent or Parents

DFA, Roxas Blvd., Manila, 1/2002

(Place and Date of Report)

Name of Child in full Mr. Ramuel Mendoza RaagasSex Male
Date of BirthNovember 14 , 1974 ;hour11m30 a.m.
Place of Birth (in full) Boston Lying-in Hospital, Boston, Massachusetts, USA
Civil Status of Parents Married
FATHER
Full NameDr. Manuel Suelto Raagas
*Race Malay ReligionRoman Catholic
Date of BirthFebruary 8, 1947
OccupationPhysician, Med. Professor
Present residence4 Garvey Rd., Framingham
Massachusetts, 01701-3072, U.S.A.
BirthplaceAmlan, Negros Oriental
Naturalized (if foreign born)

Registered as Philippine citizen atRegistry
Division, City of Boston (Suffolk, MA, USA)
OnMarch 7, 1975

Passport No. 257990 (K203795)issued by
Department of Foreign Affairs, Manila
Dated June 7, 1974
Valid to June 6, 1978
Precise periodsand places of Philippine residence:
1947-66Amlan, Negros Oriental
1966-70Sampaloc Avenue, Makati, Rizal
and Malate, Manila
MOTHER
Full NameMrs. Herminia Mendoza Raagas
Name before marriageHerminia Pastor Mendoza
*Race MalayReligionRoman Catholic
Date of BirthMarch 28, 1947
OccupationWife
Present residence4 Garvey Rd., Framingham
Massachusetts, 01701-3072, U.S.A.
BirthplaceDipolog City, Zamboanga
Naturalized (if foreign born)

Registered as Philippine citizen atRegistry
Division, City of Boston (Suffolk, MA, USA)
OnMarch 7, 1975

Passport No. 257978 (K203783)issued by
Department of Foreign Affairs, Manila
Dated June 7, 1974
Valid to June 6, 1978
Precise periodsand places of Philippine residence:
1947-67060 Quezon Avenue, Dipolog City
Zamboanga del Norte 7100
1967-8Ermita, Manila
1968-9San Miguel, Bulacan
1969-70742-A Malvar St., Malate, Manila
Precise periods and places of Philippine residence together:
December 1970-
June 27, 1974
1789-D M. Adriatico St., MalateCity of Manila
June 29,1978-83
1983-87
1987-October 1988
November 1988
Cardona Street
Hormiga Street
2084 Carmel St., San Miguel Village
#2 Aquarius St., Bel Air Village
ertswhile
Municipality
of
Makati
Place and date of marriage Municipal Board, City Hall, Manila; December 29, 1970
Number of previous children One (1)Number now living Five (5)
Name and address of physician or nurse Theodore C. Barton M.D., Boston Lying-in Hospital

*Caucasean, Malay, Negroid, Indian or Mongolian
(Signature of parent, physician, or nurse)

(WHEN REPORTED BY MAIL, SIGN IN THE

PRESENCE OF TWO WITNESSES)


Declared to in our presence this
Day of , 2002
At
(Witness)
(Witness)
(Address)
(Address)

(WHEN REPORTED IN PERSON USE THIS FORM)

Subscribed and sworn to before me this
Day of January, 2002
At the Department of Foreign Affairs complex along Roxas Boulevard, Pasay City of the Philippines.
(SEAL)


PHILIPPINE CONSULATE
At

, 2002

The foregoing information was furnished by (father, mother, physician, nurse) and supported by (affidavit, physician's certificate from local authorities). This report has been executed in triplicate copy issued to parents, copy transmitted to the Department of Foreign Affairs, Manila, and placed in the files of this office.

REMARKS






(SEAL)

of the Philippines