REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BOHOL ) S.S.

MUNICIPALITY OF JAGNA )
REGISTRY NO. _________________

AFFIDAVIT OF ADMISSION OF PATERNITY

I, SAMSON ANDILAILA , single, of legal age, Filipino citizen,

and a resident of Poblacion, Jagna, Bohol , Philippines, after having been
duly sworn to in accordance with law, declare that:

1. I am the biological father of ELHA KHOAYAW , who is my illegitimate child;

2. Said child was delivered by my then girlfriend , now my wife ,BARBIE KHOAYAW
on 01 SEPTEMBER 2019 in PAANAKAN HOSPITAL , TAGBILARAN CITY,
BOHOL, PHILIPPINES ;

3. That at the time of the birth of said child, we are not yet married;

4. That I hereby admit under oath my paternity of the child, ELHA KHOAYAW;

5. That I am executing this affidavit to attest to the truth of the foregoing facts for the
purpose of admission of paternity and for my said child to bear my surname , thereby
changing the child’s name from ELHA KHOAYAW TO ELHA KHOAYAW
ANDILAILA and for whatever legal purpose this affidavit may serve.

6. I hereby certify that the statements made herein are true and correct to the best of my
knowledge and belief.

7. In truth whereof, I have hereunto affixed my signature this ____________________, in

Tubigon, Bohol, Philippines.

SAMSON ANDILAILA
Name of Father-Affiant

SUBSCRIBED AND SWORN TO before me this _______________________________in

Jagna, Bohol, Philippines.

ATTY. NAKIL LALA

Notary Public
DOC. NO.:________;
PAGE NO.:_______;
BOOK NO.:_______;
SERIES OF 2019.