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Republic of The Philippines) City of - ) S.S. X - X

1. An affidavit is presented by a father acknowledging his biological child and allowing the child to use his surname. 2. The father states that he is the biological father of the child named, who was born on a specific date to the named biological mother. 3. The affidavit is executed to comply with the provisions of Republic Act No. 9255 and allow the child to use the father's surname on the Certificate of Live Birth.

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167 views1 page

Republic of The Philippines) City of - ) S.S. X - X

1. An affidavit is presented by a father acknowledging his biological child and allowing the child to use his surname. 2. The father states that he is the biological father of the child named, who was born on a specific date to the named biological mother. 3. The affidavit is executed to comply with the provisions of Republic Act No. 9255 and allow the child to use the father's surname on the Certificate of Live Birth.

Uploaded by

CarlMarkInopia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

City of _________ ) S.S.


x--------------------------x

AFFIDAVIT TO USE THE SURNAME OF THE FATHER/ACKNOWLEDGMENT

I, __________________________ of legal age, Filipino 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 the biological mother of the child is _________________________________.

3. That my child _____________________________ was born on _____________________ at


____________________.

4. That the facts of 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 as my child
and legal heir.

6. That I am allowing my child _______________________________ to use my


surname __________________ to be his surname in his 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 ______________day of


_______________ at _________________ City, Philippines.

(Name of Father)
Affiant

SUBSCRIBED AND SWORN to before me this ______________ day of ________________


in the City of _____________________, Philippines, affiant exhibiting to me his competent evidence of
identity by way of ________________________ issued at _______________, Philippines
on _________________________.

Doc No. : _____


Page No.: ______
Book No.: ______
Series of 2013 Notary Public

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