Republic of the Philippines )

PROVINCE OF ILOCOS SUR )S.S.

VIGAN CITY )
x-------------------------------------------------x

AFFIDAVIT OF ADMISSION OF PATERNITY

I, ______________________, of legal age, single/married, Filipino citizen and with residence at

______________________, after having been duly sworn to in accordance with law, do hereby
declare that:

1. I am the biological father of the child ____________________ who was born on ___________ in
___________________;

2. At the time of the birth of the said child, I was not legally married to the said child’s biological
mother;

3. I hereby acknowledge my paternity/filiation of the said child;

4. I am giving my consent for the child to use my surname ___________ and the same be reflected to
the child’s birth certificate/Report of Birth;

5. I am executing this Affidavit to attest to the truth of the foregoing facts and for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands and affixed my signature this ___ day of
_________ in Vigan City, Ilocos Sur.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of __________ in Vigan City,
Ilocos Sur, Philippines, affiant exhibiting his/her PRC ID No.__________________ issued at
_____________ on ________________. I certify that I personally examined the affiant and that
he/she voluntarily executed the foregoing affidavit and understood the contents thereof.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2023