AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME
I, ____________________ of legal age, _______ citizen, and presently residing at
___________________________________________, after having been duly sworn to in
accordance with law, do hereby depose and say:
1. That I am the biological father of ____________________________________;
2. That my child ______________________________ was born on
____________________ at
__________________________________________;
3. That the facts of birth of my child were duly registered at the
_______________________________________________________________;
4. That being the father of _____________________, I hereby acknowledge and recognize
___________________________________ as my child and legal heir;
5. That I am allowing my child _______________________________ to use my
surname to be his/her surname in his Certificate of Live Birth; and
6. 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 __ day of ______ at
____________________.
Affiant (Signature Over Printed Name)
SUBSCRIBED AND SWORN to before me this ___ day of ______ in the
____________, affiant exhibiting to me his competent evidence of identity by way of
___________________ issued at ______________________ on ________________.
Doc No. : _____
Page No.: ______
Book No.: ______
Series of Notary Public
office where birth was registered
place where you signed this affidavit
