FOREIGN SERVICE OF THE PHILIPPINES ) CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES) S.S. HONOLULU, HAWAII, U.S.A.

Affidavit of Acknowledgment of Paternity and to Use the Surname of Father

I, __________________________________________________, of legal age, single/married, Filipino citizen and a resident of

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

1.

That

am

the

biological

father

of

the

minor/child,

______________________________________________________, who was born on ______________________________ in

________________________________; 2. That at the time of the birth of said minor/child, I was not legally married to his/her biological mother; 3. That I hereby acknowledge my paternity / filiation of the minor / child, ____________________; 4. That I am giving my consent for the minor/child to use my surname and that the same be reflected in his/her birth certificate; 5. That I am executing this affidavit to attest to the truth of the foregoing facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of ______________ 20, ____ in the City and County of Honolulu, Hawaii, USA.

_______________________________ (Printed Name and Signature of Father)