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I, Jason Gaje of legal age, Filipino and a resident of Brgy. Mayana, Guiuan Eastern Samar, after having
been duly sworn to in accordance with law, depose an say:
That I have a Live-in partner and we have now a baby, who was born on June 8, 2017;
That I want that my child shall bear my surname and he shall be named as Matteo Jael Gaje;
That said surname of our child is likewise with the consent of my wife, Mariel Bantilan, although we are
living without the benefits of marriage;
That I am executing this affidavit to asses and show the truth and veracity of my statement above.
In witness where of, I have here and to set my hand this 11 of June 2017 in Guiuan Easter Samar.
JASON GAJE
Applicant
Witness:
1. 2.
Subscribed &, sworn to before me this 11 of June 2017 in Guiuan Eastern Samar
Doc. No.
Page No.
Series of 2017