Republic of the Philippines)

San Francisco, California ) S.S. Registry No. 2016-

AFFIDAVIT OF ADMISSION OF PATERNITY

I, ________________________________________ of legal age, and presently residing at

____________________________________________________________, after having been

duly sworn to in accordance with law do hereby depose and say:

1. That I am the biological father of the child,

_________________________________________, who was born on

________________________ at ________________________________________.

2. That at the time of birth of said child, I am not married to his/her mother,

___________________________________.

3. That I hereby acknowledge my paternity/filiation to the child,

___________________________________.

4. That I am executing this affidavit to attest the truth of the foregoing facts and for

whatever legal purpose it may serve.

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

________________________ at _________________________________________.

_______________________________
Print Name and Signature
of the Father

SUBSCRIBED AND SWORN to before me this ______ day of

_____________________ 20___ at the Philippine Consulate General, San Francisco, U.S.A.

____________________________
Signing Officer