Republic of the Philippines )

CITY OF CAGAYAN DE ORO ) S.S.

AFFIDAVIT OF CONSENT TO
USE THE SURNAME OF FATHER

I, ALLAN RAY O. TAAL, of legal age, Filipino and a resident

of Tablon, Cagayan de Oro City, after having been sworn to an
oath in accordance with law hereby depose and say:

1. That I am the biological father of LEJAN RAFFAEL

SABANDAL, whose mother is JESA NIA D. SABANDAL;

2. That my child, LEJAN RAFFAEL SABANDAL - was born on

June 19, 2015 at Tablon Health Center, Cagayan de Oro
City;

3. That the fact of birth of my child, LEJAN RAFFAEL

SABANDAL was duly registered at the Civil Registrar
Office of Cagayan de Oro City;

4. That I, ALLAN RAY O. TAAL, being the father of LEJAN

RAFFAEL SABANDAL had acknowledged and recognized
him as my child and legal heir/s;

5. That I am allowing my child, LEJAN RAFFAEL SABANDAL

to use my surname TAAL to be his surname in his
Certificate of Live Birth;

6. That my child shall be known as LEJAN RAFFAEL S.

TAAL;

7. That I execute this affidavit to attest the truth of the

above facts for whatever legal intents and purposes it
may serve and in compliance with the provision of
Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this 7th day of February 2017 in the City of Cagayan de
Oro, Philippines.

ALLAN RAY O. TAAL

Affiant

SUBSCRIBED AND SWORN TO before me this 7th day of

February 2017 in the City of Cagayan de Oro, Philippines.
Doc. No. ________;
Page No. ________;
Book No.________;
Series of 2017.