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Affidavit of Acknowledgment Blank

This affidavit acknowledges the paternity and consents to use of the father's surname of a child. It states that the affiant is the biological father of the child named, who was born on a specific date in a hospital. It acknowledges paternity and filiation of the child. The affiant gives consent for the child to use his surname and for this to be reflected in the birth certificate. The affidavit is being executed to attest to these facts and support the child's claim with relevant registration authorities.

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alexredrose
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2K views1 page

Affidavit of Acknowledgment Blank

This affidavit acknowledges the paternity and consents to use of the father's surname of a child. It states that the affiant is the biological father of the child named, who was born on a specific date in a hospital. It acknowledges paternity and filiation of the child. The affiant gives consent for the child to use his surname and for this to be reflected in the birth certificate. The affidavit is being executed to attest to these facts and support the child's claim with relevant registration authorities.

Uploaded by

alexredrose
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NEGROS ORIENTAL) S.S.


CITY OF DUMAGUETE......................)

AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY AND


CONSENT TO USE THE SURNAME OF FATHER

I, __________________, of legal age, Filipino, and a resident of


Lopez, Quezon Province, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the biological father of _______________ who was born


on ________________ in Philippine General Hospital, Metro Manila,
Philippines;

2. That at the time of the birth of ____________________, I was not


legally married to his biological mother _________________;

3. That I hereby acknowledge my paternity/filiation of


________________;

4. That I am giving my consent for ______________ 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 statement of fact and to support the claim of my son ARVY
RODULFO with the Local Civil Registrar (LCR), National Statistics Office
(NSO) or Philippine Statistics Authority (PSA) and for whatever it may serve
him best.

IN WITNESS WHEREOF, I have hereunto set my hand this


_____________ in ________________, Philippines.

Affiant
ID NO. _______________________

JURAT

SUBSCRIBED AND SWORN to before me this _____________ in


________________, Philippines.

Doc No.: ___


Page No.: ___
Book No.: ___
Series of 2017.

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