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I, ____________________ of legal age, _______ citizen, and presently residing at

___________________________________________, after having been duly sworn to in

accordance with law, do hereby depose and say:

full name of child

1. That I am the biological father of ____________________________________;

full name of child

2. That my child ______________________________ was born on
date of bith
____________________ at
place of birth

3. That the facts of birth of my child were duly registered at the

office where birth was registered

full name of child

4. That being the father of _____________________, I hereby acknowledge and recognize
full name of child
___________________________________ as my child and legal heir;

full name of child

5. That I am allowing my child _______________________________ to use my
surname to be his/her surname in his Certificate of Live Birth; and

6. That I execute this affidavit to attest to the truth of the above facts in compliance with the
provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of month

______ at
place where you signed this affidavit

printed full name here

Affiant (Signature Over Printed Name)

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 Notary Public