AFFIDAVIT OF BIRTH OF [APPLICANT NAME]
I, [Affiant Name], a citizen of [Country of Citizenship] and currently residing in [City, Country
of Residence] do hereby state that the following is true and accurate to the best of my
knowledge:
1. I am the [relationship] of [Applicant Name].
2. I was born on [Affiant Birthdate] in [City, Country], and I know of [his/her] birth because of
my relationship to [him/her].
3. In [Month of Year Applicant was born], I was living in [City, Country].
4. [Applicant Name] was born at [Place of Birth (i.e. name of hospital, home, etc.)] located in
[City, Country] on [Applicant Birthdate].
5. [Applicant Name] was born to [Father’s Name] and [Mother’s Name].
6. I know that [Applicant Name] was born on this date because [explanation of how affiant
knows of the birth].
[Affiant Name]
[Affiant Signature]
Subscribed and sworn to before me on [Date Notary Signs Document] in [City and Country
where executed].
[Notary Signature]
[Notary Stamp]