Republic of the Philippines Province of Northern Samar S.S. Municipality of Catarman AFFIDAVIT TO USE THE SURNAME OF THE FATHER I, ________________________, of legal age, Filipino, 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 fact of birth of my child was duly registered at the Office of the _____________________ Civil Registrar. 5. That I, ________________________________ being the father of ________________________________, hereby acknowledged and recognized him/her as my child and legal heir. 6. That I am allowing my child ________________________________ to use my surname ______________________ to be his/her surname in his/her 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 ____________ at Catarman, Northern Samar, Philippines. _____________________________ Aﬃant __________________________ SUBSCRIBED AND SWORN to before me this ________________ at Catarman, Northern Samar, affiant exhibiting his competent proof identity the details of which is shown below his name.

Affidavit - Use of Surname-Format

Download DOCX Report

Upload
lorraine-anne-quibranza
View
28
Download
14

Embed Size (px)

DESCRIPTION

for a child born out of wedlock

Citation preview

Republic of the PhilippinesProvince of Northern Samar S.S.Municipality of Catarman

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, ________________________, of legal age, Filipino, 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 fact of birth of my child was duly registered at the Office of the _____________________ Civil Registrar.

5. That I, ________________________________ being the father of ________________________________, hereby acknowledged and recognized him/her as my child and legal heir.

6. That I am allowing my child ________________________________ to use my surname ______________________ to be his/her surname in his/her 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 ____________ at Catarman, Northern Samar, Philippines.

_____________________________Affiant__________________________

SUBSCRIBED AND SWORN to before me this ________________ at Catarman, Northern Samar, affiant exhibiting his competent proof identity the details of which is shown below his name.

Doc No. ______;Page No. ______;Book No. ______; Series of 2014.