REPUBLIC OF THE PHILIPPINES)

CITY OF LAS PIÑAS )SS.

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AFFIDAVIT OF ACKNOWLEDGEMENT OF PATERNITY

AND TO USE THE SURNAME OF FATHER

I, RAFAEL DE ASIS NUYAD, of legal age, married, Filipino

citizen with postal and residence address at No. 108 Malagasang II-
D, City of Imus, Cavite, Philippines, after having been duly sworn to
in accordance with law do hereby depose and say:

1. That, I am the biological father of the minor/child, JUSTIN

BELGIRA NUYAD, who was born in West Visayas State
University Medical Center, Jaro, Ilo-Ilo City on June 23,
2004;

2. That, at the time of the birth of said child, I was not legally
married to his biological mother;

3. That, I hereby acknowledge my paternity;

4. That, I am giving my consent for the child to use my

surname and that the same be reflected in his birth
certificate;

5. That, I am executing this affidavit to attest to the truth of

the foregoing facts and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

th
28 day of February, 2022 in Imus City, Cavite, Philippines.

RAFAEL DE ASIS NUYAD

(Printed Name and Signature of Father)

SUBSCRIBED AND SWORN to before me this 28th day of

February, 2022, at Las Piñas City, Metro Manila, Philippines.