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Affidavit of Acknowledgement of Paternity

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REPUBLIC OF THE PHILIPPINES)

_________________________)SS.
x------------------------------------------------x

AFFIDAVIT OF ACKNOWLEDGEMENT OF PATERNITY AND TO USE THE


SURNAME OF FATHER

I, _______________________________, of legal age, single, Filipino citizen and a


resident of _______________________________ after having been duly sworn to in
accordance with law do hereby depose and say:
1. That I am the biological father of the minor/child, _________________ who was
born on _____________ in ___________________________________;
2. That at the time of the birth of said child, I was not legally married to her biological
mother;
3. That I hereby acknowledge my paternity, __________________________;
4. That I am giving my consent for the child to use my surname and that the same be
reflected in her birth certificate;
5. That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____day of _______ in


______________________.
________________________________
(Printed Name and Signature of Father)

SUBSCRIBED AND SWORN to before me this ______day of ___________at


______________, Philippines. Affiant exhibited to me his ___________________with
no._________________ valid until __________________.

Doc. No.______;
Book. No._____;
Page No. _____;
Series 2015

NOTARY PUBLIC

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