Republic of the Philippines)

City of Binan, Laguna

) S.S.
AFFIDAVIT OF PATERNITY AND CONSENT
TO USE THE SURNAME

I, DOMINGO BAGARINO ECIJA, SR., Filipino, of legal

age, married, and a resident of Block 29, Lot 14, Southville 5,
Timbao, Binan City, Laguna, after having been sworn in
accordance with law, do hereby respectfully depose and state:
That I am the biological father of the minor, DONALYN
RAAGAS that was born on September 5, 2002 in Binan City,
Laguna. A true and faithful machine reproduction of the
Certificate of Birth is hereby attached as Annex A;
That at the time of the birth of said minor, I was not legally
married to her biological mother, MARILYN QUIRANTE
RAAGAS, but I was subsequently married to the latter on June 5,
2004. A true and faithful machine reproduction of the Certificate
of Marriage is hereby attached as Annex B;
That I hereby acknowledge paternity to the aforesaid
minor;
That I am giving my consent for the minor to use my
surname ECIJA and that the same be reflected in her birth
certificate;
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 _____________ at _____________ City, Philippines.
DOMINGO B. ECIJA, SR.
(Affiant)
JURAT/CERTIFICATION
SUBSCRIBED AND SWORN to before me this ___th day of
_______ at the ___________. I hereby certify that I personally
examined the affiant and that I am satisfied that he voluntarily
executed and understood his affidavit.

NAME
PLACE
Domingo B. Ecija, Sr.
________

CTC NO.
______

DATE
_______

NOTARY PUBLIC
Doc. No. .........:
Page No. .........;
Book No. .........;
Series of 2015