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    Use Surname of Father (Pro Forma)

    Uploaded by

    AC Lu
    This affidavit is being filed by a 25-year-old Filipino woman residing in La Trinidad, Benguet to use the surname of her child's father on her daughter's birth certificate. Her daughter was born on August 7, 2014 in La Trinidad, Benguet, Philippines. She is filing this affidavit at the local civil registry office in La Trinidad, Benguet in accordance with Philippine law, and swears that the statements made in the affidavit are true and correct to the best of her knowledge.

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    Use Surname of Father (Pro Forma)

    Uploaded by

    AC Lu
    125 views1 page
    This affidavit is being filed by a 25-year-old Filipino woman residing in La Trinidad, Benguet to use the surname of her child's father on her daughter's birth certificate. Her daughter was born on August 7, 2014 in La Trinidad, Benguet, Philippines. She is filing this affidavit at the local civil registry office in La Trinidad, Benguet in accordance with Philippine law, and swears that the statements made in the affidavit are true and correct to the best of her knowledge.

    Original Description:

    for the use of surname

    Copyright

    © © All Rights Reserved

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    This affidavit is being filed by a 25-year-old Filipino woman residing in La Trinidad, Benguet to use the surname of her child's father on her daughter's birth certificate. Her daughter was born on August 7, 2014 in La Trinidad, Benguet, Philippines. She is filing this affidavit at the local civil registry office in La Trinidad, Benguet in accordance with Philippine law, and swears that the statements made in the affidavit are true and correct to the best of her knowledge.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    125 views1 page

    Use Surname of Father (Pro Forma)

    Uploaded by

    AC Lu
    This affidavit is being filed by a 25-year-old Filipino woman residing in La Trinidad, Benguet to use the surname of her child's father on her daughter's birth certificate. Her daughter was born on August 7, 2014 in La Trinidad, Benguet, Philippines. She is filing this affidavit at the local civil registry office in La Trinidad, Benguet in accordance with Philippine law, and swears that the statements made in the affidavit are true and correct to the best of her knowledge.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines) Registry No: ___________

    La Trinidad, Benguet ……….) S.S.

    AFFIDAVIT TO USE THE SURNAME OF FATHER


    I, ______________, FILIPINO, MARRIED, 25 years old, a resident of __K.M.3, Pico, LA
    TRINIDAD, BENGUET, after having been duly sworn to in accordance with law, hereby declare that:

    1. I am seeking the use of the surname _______________ in:


    a. my Certificate of Live Birth/ Report of Birth, pursuant to R.A. No. 9255;

    b. X the Certificate of Live Birth of ______________________


    (Complete Name of the Child)
    who is my DAUGHTER pursuant to R.A. No. 9255;
    (Relationship of the Affiant with the Child)

    2. I / He / She was born on AUGUST 7, 2014 at LA TRINIDAD, BENGUET,


    PHILIPPINES;
    (Date of Birth) (Municipality) (Province) (Country)
    3. My/ The birth was recorded under Registry No. __2015-2352___ on ___N/A____; (if
    applicable)

    4. The Public Document or the Private Handwritten Instrument was recorded under Registry No.
    __N/A__ on ____________N/A_____________ at the Local Civil Registry Office (LCRO);
    Philippine Foreign Service Post (PFSP) of ____________N/A_____________ (if applicable)
    (Municipality) (Province) (Country)
    5. I am filing this AUSF at the LCRO/PFSP of ___LA TRINIDAD_,___ BENGUET,__
    PHILIPPINES___ in (Municipality) (Province)
    (Country)
    accordance with R.A. No. 9255 and its Revised Implementing Rules and Regulations.

    6. I hereby certify that the statements made herein are true and correct to the best of my knowledge
    and belief.

    7. In witness whereof, I hereby affix my signature this 5th day of July, 2018 at La Trinidad,
    Benguet, Philippines.

    ________________________________ _
    Signature over printed name of Affiant

    SUBSCRIBED AND SOWRN TO before me this 5th day of July, 2018 at La Trinidad, Benguet,
    affiant exhibiting her ___CTC No. ___________________ issued at
    _______________________________on __________________________. I certify that I personally
    examined the affiant and that she voluntarily executed the foregoing affidavit and understood the
    contents thereof.

    AFFIDAVIT TO USE SURNAME OF THE FATHER 1

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