AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, ____________________ of legal age, _______ citizen, and presently residing at

___________________________________________, after having been duly sworn to in

accordance with law, do hereby depose and say:

full name of child

1. That I am the biological father of ____________________________________;

full name of child

2. That my child ______________________________ was born on
date of bith
____________________ at
place of birth
__________________________________________;

3. That the facts of birth of my child were duly registered at the

_______________________________________________________________;
office where birth was registered

full name of child

4. That being the father of _____________________, I hereby acknowledge and recognize
full name of child
___________________________________ as my child and legal heir;

full name of child

5. That I am allowing my child _______________________________ 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 month

______ at
place where you signed this affidavit
____________________.

printed full name here

Affiant (Signature Over Printed Name)

SUBSCRIBED AND SWORN to before me this ___ day of ______ in the

____________, affiant exhibiting to me his competent evidence of identity by way of
___________________ issued at ______________________ on ________________.

Doc No. : _____

Page No.: ______
Book No.: ______
Series of Notary Public