Republic of the Philippines) Province of ____________________) S.S.

City/Municipality of _____________)x - - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF ILLEGITIMACY

I, _____________, of legal age, Filipino, and a resident of _____________, Philippines, after having been duly sworn to in accordance with law, hereby depose and state:

That I am the mother of _____________ who was born on _____________ at the _____________ Hospital, _____________ City, Philippines. That as appearing in the records of Office of the Civil Registrar of the City of _____________, Philippines, the father of the said child is _____________, who is a _____________ citizen. The same is certified by the attached Certificate of Live Birth of the said child. That I hereby affirm and attest to the truth of the fact that the father of the abovementioned child is indeed _____________. That I also declare that under the laws of the Philippines or of the _____________, I and _____________ were not incapacitated to marry each other at the time of the conception or birth of the said child, nor are we incapacitated to marry each other now or in the future. That I am executing this affidavit to attest to the truth of the foregoing facts. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.

Affiant

(JURAT)