CONSENT TO USE SURNAME OF FATHER I, _________________________________________________, a citizen of _______________________, of legal age, and presently residing at ______________ ____________________________________________________________________, after having been duly sworn to in accordance with law, do hereby depose and state: That I arrived in Hong Kong/Macao on _______________________ and I am now a holder of _______________________________ (please state status of stay in Hong Kong /Macao employment visa, unconditional stay, or right of abode);
That I am presently employed at _____________________________________
_________________________ as ________________________________________; That sometime in __________________, I met _________________________ a Filipino national, with whom I later had a relationship with; That as a result of this relationship, she conceived and gave birth to a child on _______________________ in ______________________, and we named him/her _____________________________________; That I am not legally married to Ms. _________________________________, the mother of my child, in accordance with Philippine laws; That I hereby admit under oath the paternity of _____________________; and That I further acknowledge that I am the natural father of said child and I am willing to give him/her all his/her rights as my child under the laws of the Philippines, including the right to carry and use my surname ____________________________ as his/her own pursuant to Republic Act No. 9255. IN WITNESS WHEREOF, I have hereunto affixed my signature this ______day of ________________________ 20___ in Hong Kong SAR / Macao SAR. _________________________ Affiant SUBSCRIBED AND SWORN to before me this _____ day of ______________ 20__ in Hong Kong SAR, affiant exhibiting to me his Philippine Passport/ Hong Kong/ Macao identity card no. ____________________ issued on ____________________ in ________________________________. Doc. No. Page No. Book No. Series of Svc. No. O.R. No. Fee Paid