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__.