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
full name of child
full name of child
date of bith
place of birth
office where birth was registered
full name of child
full name of child
full name of child
place where you signed this affidavit
printed full name here