AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, ______________________________________ of legal age, Filipino and residing at

_______________________________________, after being sworn to in accordance with law,
state under oath:
1. That I am the biological father of the child _________________________________.

2. That my child ________________________________ was born on

___________________ at ______________________________________________.

3. That the facts of birth of my child was duly registered at

_________________________________.

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 which

is ________________________ to be his/her surname in his Certificate of Live Birth.

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 affixed my signature this ___ day of ___________

2018 at __________________________________

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of _______________ 2018 at

____________________, affiant exhibited to me his ______________________________ issued
at ____________________ on ___________________ as competent evidence of identity.

Doc. No.: ___

Page No.: ___
Book No.: ___
Series of: _____