Republic of the Philippines )

_____________________ )S.S.

AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, RODERICK BISONIA RITUAL, single, of legal age, Filipino citizen, and

presently residing at Barangay Suklayin, Baler, Aurora, after having been duly sworn to
in accordance with law, do hereby depose and say:

1. That I am the biological father of ANGEL BENEDICTO;

2. That my child, ANGEL BENEDICTO was born on December 5, 2010 at San

Narciso, Quezon;

3. That the facts of birth of my child were duly registered at the Office of the Civil
Registrar General of San Narciso, Quezon;

4. That being the father of ANGEL BENEDICTO, I hereby acknowledge and

recognize her as my child and legal heir;

5. That I am allowing my child, ANGEL BENEDICTO to use my surname to be

his/her surname in his Certificate of Live Birth; and

6. 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 __ day of January

2021 at ____________________.

RODERICK BISONIA RITUAL

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of January 2021 in

_________________, affiant exhibiting to me his competent evidence of identity by way
of TIN no. 246-804-706 issued at Mandaluyong City on Oct. 23, 2006.

Doc No. : _____ ;

Page No.: ______;
Book No.: ______ ;
Series of 2021