Republic of the Philippines }

City of Cebu }S.s

AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, Luis Kent Autida of legal age, Filipino citizen, and presently residing at 54 – A Our
Lady of Remedy St. Mabolo Cebu City, after having been duly sworn to in accordance with law,
do hereby depose and say:

1. That I am the biological father of Luke Kenric Lepiten;

2. That my child Luke Kenric Lepiten was born on February 25, 2016 at Cebu City;

3. That the facts of birth of my child were duly registered at the Office of the Civil
Registrar – Cebu City;

4. That being the father of Luke Kenric Lepiten, I hereby acknowledge and recognize
Luke Kenric Lepiten as my child and legal heir;

5. That I am allowing my child Luke Kenric Lepiten to use my surname to be her

surname in his Certificate of Live Birth; and

6. That I execute this affidavit to attest to the truth of the above facts in compliance with
the provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of October 2021
at Cebu City.

Luis Kent Autida

Affiant

SUBSCRIBED AND SWORN to before me this 26th day of October 2021 in Cebu City,
affiant exhibiting to me his competent evidence of identity by way of LTO G06-19-009217
issued at Cebu City an valid until 08/15/2024.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2021