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AFFIDAVIT TO USE THE SURNAME OF THE FATHER
I, ________, of legal age, Filipino, residing at ________, after being sworn into law do hereby depose and state that:
1. I am the mother of ________ who was born on ________ in ________;
2. ________, my child's father, has acknowledged the paternity through an Affidavit of Paternity which was recorded under Registry No. ________ on ________ at the Local Civil Registry Office of ________;
3. I am executing this affidavit for my child to use their father's surname, ________, and that the same be reflected in my child's Certificate of Live Birth, pursuant to Republic Act No. 9255 and its Revised Implementing Rules and Regulations;
________
SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________ affiant, ________, personally appeared before me and exhibited to me their Driver's License no. ________ which is valid until ________.
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