REPUBLIC OF THE PHILIPPINES)

PROVINCE OF [PROVINCE] )S.S.

CITY/MUN. OF [TOWN] )
x-------------------------x

AFFIDAVIT OF PATERNITY
AND USE OF FATHER’S SURNAME
I, [CLICK HERE AND TYPE NAME] , of legal age, [civil status] ,
Filipino, and a resident of [Address] , after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I have cohabited without being lawfully married with [NAME OF

MOTHER] Filipino Citizen, of legal age, and resident of
______________ Philippines and that during our cohabitation a child
was born in the name of [NAME OF CHILD WITH MOTHERS SURNAME];

2. That I am the father of [NAME OF CHILD WITH MOTHERS SURNAME]

who was born on _________________ at
______________________, ______________________ and his
fact of birth was duly recorded with the Office of the Local Civil Registrar of
_________________, Philippines;

3. That being the father of _____________________, I hereby

acknowledge and recognize
___________________________________ as my child and legal
heir;

4. I am allowing my child _______________________________ to use

my surname to be his/her surname in his Certificate of Live Birth;

5. That I am executing this affidavit to attest to the truth of the foregoing facts
for all legal intents and purposes;

IN TESTIMONY WHEREOF, I have hereunto set my hand this 8th day

of March, 2019 at [Town, Province] .

[Signature Over Printed Name]

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ______ in

the____________, affiant exhibiting to me his competent evidence of identity
by way of___________________ issued at ______________________ on
________________.

Doc. No. _________;

Page No. _________;
Book No. _________;
Series of 2019.