REPUBLIC OF THE PHILIPPINES )

CITY OF ___________________ ) SS

AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY AND TO USE THE

SURNAME OF THE FATHER

I, Marco Velasco Gregorio, of legal age, married to Michelle Gregorio, Filipino citizen
and a resident of 412 Lakas Street, Bacood, Santa Mesa Manila, after having been duly
sworn to in accordance with law, do hereby depose and state the following;

1. That I am the biological father of the minor/child, Zoie Alexandra Calvelo, who was
born on December 1, 2009 in Fabella Hospital Manila;

2. That at the time the child was born I was not legally married to his/her biological
mother;

2. That I am acknowledging my paternity over the child whose name appears above.

3. That I hereby give my consent for the child to use my surname and that the same
be reflected on his Certificate of Live Birth.

4. 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 THEREOF, I have hereunto set my hands this ____ of _______, 2014, in
the City of _________________, Philippines.
______________________________
MARCO VELASCO GREGORIO
Affiant

SUBSCRIBED AND SWORN TO before me this _____________ of ___________ at

__________, Philippines. Affiant exhibited to his _(government issued ID), with number
_______________ valid until ____________.

Doc No. _______

Page No. _______
Book No. _______
Series of 2013