REPUBLIC OF THE PHILIPPINES )Province of ) S.S.TreceMartires City )x - - - - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT TO USE THE SURNAME OF THE FATHER / ACKNOWLEDGMENT

           I, ___________________________________, of legal age, Filipino, and presently residing at ___________________________________________________, after having been duly sworn to in accordance with law, do hereby depose and state:

1. THAT I am the biological father of ____________________________;

2. THAT the biological mother of the child is _________________________;

3. THAT my child _________________________________ was born on _______________________ at ________________________________;

4. THAT the facts regarding the birth of my child were duly registered at the Office of the ______________________ Civil Registrar.

5. THAT I, _____________________________ being the father of ________________________________, hereby acknowledged and recognized him/her as my child and legal heir.

6. THAT I am allowing my child _______________________________ to use my surname ____________________ to be his/her surname in his/her Certificate of Live Birth.

7. THAT I execute this affidavit to attest to the truth of the above facts in compliance with the provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ of ___________________________ at _______________________________________.   

_____________________________Affiant

ID NO.: _________________Issued on: ________________Issued at: ________________

SUBSCRIBED AND SWORN to before me, this _______ of _____________________ in _________________________________, affiant exhibiting to me his identifications as indicated above.                                     

Doc.  No. :  ________; NOTARY PUBLICPage  No. :  ________;Book No. :  ________;Series of 20__.