Republic of the Philippines )

Province of Cavite ) S.S

Trece Martires City )

AFFIDAVIT OF ADMISSION OF PATERNITY

I, ___________________, of legal age, single, Filipino citizen, and a resident of

________________________, having been duly sworn to in accordance with law, hereby
depose and state:

1. That I am the father of the one _________________ was conceived and born on
____________ at ___________________;

2. That on the time of the birth of the said child I was not legally married to his
biological mother __________________________;

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

_____________;

4. That I am giving my consent for the child to use my surname and that the same be
reflected in her Certificate of Live Birth;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this ______ day of _______at
Trece Martires City, Cavite.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me in the Trece Martires City, Cavite, Philippines,
this ______ day of _______, who has satisfactorily proven to me his identity through his ______
Identification bearing the number ______, that he is the same person who is personally signed
before me the foregoing Affidavit of Admission of Paternity and acknowledged that he
executed the same.

Doc. No. : ______

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