REPUBLIC OF THE PHILIPPINES)

Province of Cam. Sur )

City of Naga )s.s.

SWORN ATTESTATION

I, (Name of Affiant –mother or guardian ), of legal age, (civil status),

Filipino and a resident of (Complete Address), after having been duly sworn
to in accordance with law, do hereby depose and state that:

1. I am the biological mother or guardian of (Name of the Child);

2. He/she is the affiant who executed the Affidavit to Use the Surname of
the Father (AUSF);

3. I hereby attest that my child/ward ____________ is fully aware of the

consequences of the use of the surname of his/her father.

IN WITNESS WHEREOF, I hereby affix my signature this ___ day of

______ 2020 at Naga City, Cam. Sur, Philippines.

_____________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of January

2020 at Naga City, Cam.Sur, Philippines. Affiant exhibited to me his/her
______________, bearing his/her photograph and signature, to prove to me
that he/she is the same person who signed and executed the foregoing
Affidavit.

Doc No. ____

Page No. ____
Book No. ____
Series of 2020