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Affidavit To Use The Surname of The Father
Affidavit To Use The Surname of The Father
1
(Revised March 2016)
Registry No. _____________
Republic of the Philippines) Date: ___________________
Province of Kalinga ) S.S By: ____________________
City of Tabuk )
3. My/ The birth was recorded under Registry No. _____________ on _______________
Registry number Date of registration
(if applicable).
4. The public document or the Private Handwritten Instrument was recorded under
Registry No. _______________ on ___________________ at the LCRO/ PFSP of
Registry No Date of Registration
5. I am filing this AUSF at the LCRO/ PFSP of Tabuk City, Kalinga, Philippines in
accordance with RA 9255 and its implementing Rules and Regulations.
6. I hereby certify that the statements made herein are true and correct to the best of my
knowledge and belief.
I certify that I personally examined the affiant and that he/ she voluntarily
executed the forgoing affidavit and understood the contents thereof.
Michelle B. Gayagay
Notary till Dec. 31, 2017
Roll No. 63190
IBP OR 1002707; 12- 15- 15
PTR 6317369; 1-4- 16
Tabuk City, Kalinga Province