REPUBLIC OF THE PHILIPPINES }

Municipality of Alfonso } S.S.

X ============================= X

AFFIDAVIT OF ADMISSION OF PATERNITY

I, ______________, after having been duly sworn to in accordance with law hereby
depose andsay:

1. That I am single, of legal age, Filipino citizen, and a resident of ___________,

______________, _______________

2. That sometime in _____, 20___, I met _____________________ of legal age,

Filipino citizen and a resident of ______________, _______, _____, with
whom I later had a relationship;

3. That as a result of said relationship, she conceived and gave birth to a

child on _____________ and she named the child, _____________;

4. That I am the biological father of the child, __________;

5. That at the time of the birth of said child, I am not legally married to ______
_______________, her biological mother;

6. That I hereby admit under oath my paternity of the child, _______________;

7. That I am executing this affidavit to attest to the truth of the foregoing facts and
forwhatever legal purposes it may serve.

IN WITNESS WHEREOF, have hereunto affixed my signature this ____ day of

___________, _________, _________, _________, Philippines.

__________________________
___________________

SUBSCRIBED AND SWORN to before me in the Municipality of Alfonso this ____ day
of March, 2017 by Immanuel T. Mojica , personally known to me, who is the same
person who personally signed before me theforegoing affidavit and acknowledged that
he executed the same.

Doc. No. ______;

Page No. _____;
Book No. ____ ;
Series of 2017.