AFFIDAVIT TO USE THE SURNAME OF THE FATHER

Note:

This is RA 9255 Form No. 1 (Rule 7.2.1) Birth Previously Registered Under the Surname of Mother.

With the effectivity of RA 9255 also known as the “Revilla Law”, children born outside of marriage may now use the surname of their father by filing the application to use the surname of the father before the Civil Registry of the place where the child was born. The application must be supported with the Certified True Copy of Child’s Birth Certificate, Affidavit to Use the Surname of the Father executed by the father himself and with conformity of the mother, and valid Government Identification Cards of the parents.

REPUBLIC OF THE PHILIPPINES)

_________________                )Sc.

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I,  __________________________, of legal age, Filipino, with residence and postal adress at ______________,under oath, alleges:

1. That I am the biological father of  _____________________________________;

2. That the biological mother of my child is __________________________________;

3. That my child, _____________________________, was born on ____________ at _________________;

4. That the facts of birth of my child, _______________, were duly registered at the Office of Civil Registrar of __________________;

5. That I, _________________________, being the father of ________________________  had acknowledged and recognized her/his as my child and legal heir;

6. That I am allowing my child,_____________________  to use my surname, _____________________, to be her/his surname, in his Certificate of Live Birth;

7. That my child shall be known as __________________;

8. That I execute this affidavit to attest the truth of the above facts for whatever legal intents and purpose it may serve and in compliance with the provision of the Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hands on this _____^TH  day of ____________,_______________.

With my consent

to use the surname of the father

of my child:

_________________________________                        

              Affiant/Father

_________________________________

                      Mother                                                                              

JURAT

SUBSCRIBED AND SWORN to before me on this _______________ in the ____________, affiant having exhibited to me his/her (Government-issued Identification Card No. ______) issued at ____________ on ______________________.

NOTARY PUBLIC

Doc. No. ______;

Page No.______;

Book No.______;

Series of 20____.