R.A. 9255 Form No. 1 (Rule 7.2.

1)
Birth Previously Registered Under the Surname of Mother

REPUBLIC OF THE PHILIPPINES ) Registry No. 2022-80

PROVINCE OF LEYTE ) SS
Municipality of Matag-ob )

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, JUDITH MALINAO OSABEL , of legal age, Filipino

with residence and postal address at BRGY. SAN VICENTE, MATAG-OB, LEYTE
under oath, alleged:

1. That I am the biological mother JUSTIN

2. That the biological father of my child is ROGELIO CATAAG AGUILAR
3. That my child JUSTIN was born on
June 10, 2004 at SAN VICENTE, MATAG-OB, LEYTE
4. That the facts of birth of my child, JUSTIN
were duly registered at the Office of the Civil Registrar of MATAG-OB, LEYTE
5. That ROGELIO CATAAG AGUILAR , being the father of
JUSTIN had acknowledged and recognized him/ her as
my child and legal heir/s;
6. That my child, JUSTIN will henceforth use the surname of
his father, AGUILAR , to be his/her
surname, in his/her Certificate of Live of Birth;

7. That my child shall be known as JUSTIN OSABEL AGUILAR

8. That I execute this affidavit to attest the truth of the above facts for whatever
legal intents and purpose it may serve and in compliance with the provision of
Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hands on this 6TH day of

JUNE, 2022 at Matag-ob, Leyte .

With my consent
to use the surname of the father
of my child:

JUDITH MALINAO OSABEL

Mother Attestation

SUBCRIBED AND SWORN to before me on this 6TH day of JUNE, 2022

at MATAG-OB, LEYTE , affiant having exhibited to me his/her Community Tax
Certificate No. 15557641 issued at MATAG-OB, LEYTE on JUNE 6, 2022

Doc. No.
Page No. FLORA MAY ANN S. PEDRANO
Book No. Acting Municipal Civil Registrar
Series No. Matag-ob, Leyte
R.A. 9255 Form No. 1 (Rule 7.2.2)

Birth Previously Registered Under the Surname of Mother

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LEYTE ) Ss.
Municipality of Matag-ob )

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, Josepina M. Labrador , of legal age, Filipino ,

with residence and postal address at Candelaria, Matag-ob, Leyte ,
under oath, allege:

1. That I am the biological mother of Elaine ;

2. That the biological father of my child is ;
3. That my child, was born on
at ;
4. That the facts of birth of my child,
were duly registered at the Office of the Civil Registrar of
5. That I, the father of my child
, had acknowledged and recognized him/ her as
my child and legal heir/s; in a separate instrument/birth certificate and allowed him to use his surname
in accordance with law;
6. That my child, will henceforth use the surname of
his father , , to be his/her surname , in his/her Certificate
of Live of Birth;

7. That my child shall be known as ;

8. That I execute this affidavit to attest the truth of the above facts for whatever
legal intents and purpose it may serve and in compliance with the provision of
Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hands on this day of

at .

ROMELITA R. PASAGUI
Affiant/ Mother

SUBCRIBED AND SWORN to before me on this day of

at , affiant having exhibited to me his Community Tax
Certificate No. issued at on .
.

Doc. No.
Page No. Engr. AGUSTIN D. PEDRANO, JR.
Book No. Municipal Civil Registrar
Series No. Matag-ob, Leyte
arate instrument/birth certificate and allowed him to use his surname
R.A. 9255 Form No. 1 (Rule 7.2.1)
Birth Previously Registered Under the Surname of Mother
Registry No. 2022-54
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LEYTE ) S.S.
Municipality of Matag-ob )

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, GENELITH BAYNO LIGUTAN ,15 years old, Filipino, Single,

with residence and postal address at BRGY. STO. ROSARIO, MATAG-OB, LEYTE, PHILIPPINES
after having been duly sworn to in accordance with law, hereby depose and state, that:

1. I am seeking to use the surname LIGUTAN in;

a. my Certificate of Live Birth / Report of Birth, pursuant to R.A. No. 9255;
b. the Certificate of Live Birth / Report of Birth of ;
who is my son / daughter, pursuant to R.A. 9255.

2 My biological mother is LILIT ONDE BAYNO ;

3 My biological father is GARY LIAMES LIGUTAN ;

4 I / He / She was born on JUNE 30, 2007 at STO. ROSARIO, MATAG-OB,

LEYTE, Philippines;

3. My / The Birth was recorded under Registry No. 2007000495 at Matag-ob, Leyte;

4. The Public Document or the Private Handwritten Instrument was recorded under
Registry No. at the Local Civil Registry of

5. I am filing this AUSF of LCRO Matag-ob, Leyte pursuant to R.A. No. 9255 and it's Revised
Implementing Rules and Regulations;

6. I hereby certify that the statements made herein are tru and correct to the best of my knowledeg and
belief;

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of JULY 2022 at
Matag-ob, Leyte, Philippines.

GENELITH BAYNO LIGUTAN LILIT ONDE BAYNO

Affiant Mother/Guardian

SUBCRIBED AND SWORN to before me on this 28th day of JULY 2022 at

MATAG-OB, LEYTE , affiant having exhibited to me his/her Community Tax Certificate
Number 15557598 issued at MATAG-OB, LEYTE on APRIL 13, 2022 .

EMERENCIANA L. TABON
HRMO/MCR Designate
Matag-ob, Leyte

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