REPUBLIC OF THE PHILIPPINES)

______________________________) Ss.
X - - - - - - - - - - - -- - - - - - - - - X

AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY, SUPPORT

AND CONSENT TO USE MY LAST NAME
I, _________________________, Filipino, of legal age,
single/married/widow/widower, and a resident of _________________________ after
having been duly sworn to in accordance with law, depose and state, that:
1. I am the natural or biological father of the minor _____________________
who was born outside of wedlock on ____________in
_____________________City;

2. The mother of my child is____________________________________;

3. That as such, I hereby oblige to provide my child

___________________________ financial support in the amount of
____________________________ monthly;

4. I likewise hereby give my consent for my child ________________ to use my

last name, and to cause the change of her last name in her certificate of live
birth from _____________ to_______________________;

5. I am executing this affidavit to apprise all those concerned of the foregoing

facts and for whatever other legal purpose it may serve.

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

_________________________ at _________________________, Philippines.

_________________________
Affiant
I.D. No. ____________________

SUBSCRIBED AND SWORN to before me this ______ day of ______________

hereat _________________________.

Doc. No.______;
Page No. ______; NOTARY PUBLIC
Book No.______;
Series of 2022.