CC FORM # 01, Series of 2010

Filipino Father
Republic of the Philippines )
City of Tagum . . . . . . . . . . . . . . .)S.S
X------------------------x

AFFIDAVIT OF ADMISSION OF PATERNITY

I, RUBY JAY M. GALACIO, of legal age, Filipino, married, and a resident of Purok 2, Mesaoy, New
Corella, Davao del Norte, Philippines, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I am the natural and biological father of CRISTIAN JAY MONTAJES who was born on July 4,
2008 at DAVAO MEDICAL CENTER, DAVAO CITY;
2. That the said child was born out of wedlock and that the name of his biological mother is
JONACRIS T. MONTAJES- GALACIO;
3. That this Affidavit is executed to attest to the truth of the foregoing facts and to inform the
Office of the City Civil Registrar of Davao City of my decision to process the registration of this
legal instrument for purposes of Legitimation;
(RA 9255 of Legitimation)

IN WITNESS WHEREOF, I have hereunto set my hand this September 13, 2019 in the City of
Tagum, Davao del Norte Philippines.

RUBY JAY M. GALACIO

(Name and Signature of Father)

With my Conformity:

JONACRIS T. MONTAJES-GALACIO
(Name and Signature of Mother)

SUBSCRIBED AND SWORN TO before me this September 13, 2019 in the City of Tagum, Davao del
Norte Philippines. Philippines, Affiant exhibited to me his Philhealth No. 16-025778468-9 as
competent evidence of identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.

Republic of the Philippines

CITY CIVIL REGISTRAR’S OFFICE
Davao City

Registered this _____ day of _________________ 20_____ after payment of the sum of
____________________ under O.R. # _____________________ and entered in the Register of Legal
Instruments (Admission of Paternity) found on Page _________, Bk. No. _____ with Registry No.
_______.