Republic of the Philippines )

Province of Isabela

Municipality of Angadanan)
x--------------------x

AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY AND

AUTHORITY TO USE SURNAME OF FATHER
I,
, Filipino, of legal age, and a resident of ___, having been duly sworn in
accordance with law, hereby depose and state:

That I am the same person executing this Affidavit;

That I am the biological father of baby girl

_____ at _____;

who was born on November

That the biological mother of my said child is ____;

That I am acknowledging paternity over my said child _____ and I am allowing

her to use my surname ___; henceforth, my child shall be named and called ___;

As such, I am executing this Affidavit to attest to the truth of the foregoing and for
other legal purposes it may serve.

IN WITNESS WHEREOF, I have set my hand this __________________ at ____.

___
Affiant

SUBSCRIBED AND SWORN to before me, this __________________ by the affiant

whom I have identified through competent evidence of identity.
WITNESS my hand and seal.