Republic of the Philippines )

Municipality of ________ )S.S

AFFIDAVIT OF ACKNOWLEDGEMENT OF PATERNITY

I, _____________________________________, of legal age, Filipino citizen, and a

resident of Brgy. Central, Casiguran, Sorsogon, after having been sworn to in accordance with
law, do hereby depose and state that:

1. I am the biological father of __________________who was born on November 2, 2015;

2. At the time of birth of______________________, I was legally married to her mother
_______________________;
3. I hereby acknowledge my paternity of __________________;
4. I am giving my consent for _______________________________ to use my surname and
that the same be reflected in her Certificate of Live Birth and other documents;
5. I am executing this affidavit to attest to the truth of the foregoing and for whatever legal
purpose that this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _______________________

in Casiguran, Sorsogon.

________________________________
Affiant
SSS ID:

SUBSCRIBED AND SWORN to before me this __________________________ at Casiguran,

Sorsogon.