AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, SHERWIN GERALD B. RUPA of legal age, 28 citizen, and presently residing at

Block 2 Lot 10 Kasayahan St., Batasan Hills, Quezon City, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the biological father of the minor / child Sherwin Rauff Raagas, who
was born January 26, 2019 at Bernardino General Hospital 2;

2. That at the time of birth of said child, I am not married to his/her mother, Ruffa
Jeanne Linda P. Raagas;

3. That I hereby acknowledge my paternity/affiliation of the minor/child, Sherwin

Rauff Raagas;

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 execute this affidavit to attest to the truth of the above facts in compliance with
the provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of January 2019 at Quezon
City Philippines.

SHERWIN GERALD B. RUPA

Affiant
(Signature Over Printed Name)

SUBSCRIBED AND SWORN to before me this ___ day of ______ in the ____________, affiant
exhibiting to me his competent evidence of identity by way of ___________________ issued at
______________________ on ________________.

Doc No. : _____

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Series of Notary Public