AFFIDAVIT OF ADMISSION OF PATERNITY AND CONSENT TO USE SURNAME OF FATHER 1 , , a citizen of age and presently residing at sworn to in accordance

with law, do hereby depose and state that:

, of legal after having been duly

1. I arrived in Hong Kong on

unconditional stay, or right of abode)

and I am now a holder of ;( please state status of stay in Hong Kong e.g. Employment via,

2. 'That

am

presently

employed

at

as

3. That sometime in

, I met whom I later had a relationship with;

, a Filipino national, with

4. That as a result of said relationship, she conceived and gave birth to a child on
in and we named the child

5. That I am not legally married to Ms.

accordance with Philippine laws;

, the mother of my child, in

6. That I hereby admit under oath the paternity of

; and

7. That I further acknowledge that I am the natural father of said child and I am hilling to
give the child all rights as my own under the laws of the Philippines, including the in accordance to Republic AG No. right to carry and use my surname 9255; IN WITNESS WHEREOF, I have hereunto affixed my signature this 20 - in Hong Kong SAR. Affiant CONSULATE GENERAL OF THE ) REPUBLIC OF THE PHILIPPINES) S. S. HONG KONG SAR 1
20- in Hong SllBSCRlBED AND SWORN to before me this -day of Kong SAR, affiant exhibiting to me his Philippine PassportIHong KongJMacau Identity Card No. issued on in

- day

of

Doc. No. Page No. Book No. Series of Svc No. O.R. No. Fee Paid

2008