REPUBLIC OF THE PHILIPPINES
Province of ) S.S. TreceMartires City
)
)
AFFIDAVIT TO USE THE SURNAME OF THE FATHER
I, ___________________________________, of legal age, Filipino, and presently residing
at ___________________________________________________, after having been duly sworn
to in accordance with law, do hereby depose and state:
1. THAT I am the biological father of ____________________________;
2. THAT the biological mother of the child is _________________________;
3. THAT my child _________________________________ was
_______________________ at ________________________________;
born
on
4. THAT the facts regarding the birth of my child were duly registered at the Office of
the ______________________ Civil Registrar.
5. THAT
I,
_____________________________
being
the
father
of
________________________________, hereby acknowledged and recognized
him/her as my child and legal heir.
6. THAT I am allowing my child _______________________________ to use my surname
____________________ to be his/her surname in his/her
Certificate of Live Birth.
7. 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 _____ of
___________________________ at _______________________________________.
_____________________________
Affiant
ID NO.: _________________
Issued on: ________________
Issued at: ________________
SUBSCRIBED AND SWORN to before me, this _______ of _____________________ in
_________________________________, affiant exhibiting to me his identifications as indicated
above.
Doc. No. : ________;
Page No. : ________;
Book No. : ________;
Series of 2024
NOTARY PUBLIC