Republic of the Philippines )

[CITY] ) s.s.

AFFIDAVIT OF ILLEGITIMACY

I, [NAME], [CITIZENSHIP], of legal age, [CIVIL STATUS], and a resident of

[ADDRESS], having been duly sworn in accordance with law, hereby depose and
state:

1. That I am the mother of [NAME] who was born on [DATE] at

[HOSPITAL/PLACE OF BIRTH];
2. That as appearing in the records of the Office of the Civil Registrar of the
City of [CITY], the father of said child is [NAME]. The same is certified by the
attached Certificate of Live Birth of said child;
3. That I hereby affirm and attest to the truth of the fact that the mather of the
above-mentioned child is indeed [NAME];
4. That I also declare that under the laws of the Philippines, I and [NAME OF
FATHER] were [not] incapacitated to marry each other at the time of the
conception or birth of the said child, nor are we incapacitated to marry each
other now or in the future; and
5. That I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have set my hands this [DATE] at [CITY],

Philippines

[NAME]
Affiant

SUBSCRIBED AND SWORN TO before me in the City of _______________ on

this day of [MONTH AND YEAR]_________________, affiant exhibiting before me his
Government Issued ID no. _______________ issued on [DATE}__________________ at
[PLACE OF ISSUANCE]_____________________.

[SIGNATURE]
[NAME]_______
Notary Public
Until [DATE]__________________
PTR No. [NUMBER] ____________
Issued at [PLACE]______________
On [DATE] ___________________

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Series of [YEAR] ___