Republic of the Philippines )

National Capital Region )

City of ) S.S.

AFFIDAVIT OF FILIATION

I, JUAN DELA CRUZ, of legal age, married, Filipino, and a resident of

BARANGAY, MUNICIPALITY, PROVINCE, after having been duly sworn
to in accordance with law, hereby depose and state that;

1. I am the legal husband of MARIA MAKILING having been

married with last DATE at MUNICIPALITY, PROVINCE;

2. We have a child, JUAN DELA CRUZ JR., born on July 28,

2005 in MUNICIPALITY, PROVINCE;

3. I am executing this affidavit in order to attest the

truthfulness of the foregoing statements and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this

__________________ in MUNICIPALITY, PROVINCE, Philippines;

TENNIE A. LABUAC
Affiant

SUBSCRIBED AND SWORN TO before me in the City of _______________

on this day of _________________, affiant exhibiting before me his
identification document _______________ with number
__________________ which will expire on _____________________.

Doc. No. ___;

Page No. ___; Notary Public
Book No. ___;
Series of 201__.