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Affidavit for Surname Use RA 9255

This document is an affidavit filed by an individual seeking to use their father's surname on their birth certificate. It details that the individual was born on a specific date in a particular place, and their birth was registered with identifying information. It further notes that documentation of their father's admission of paternity was also registered. The affidavit is being filed to update the individual's surname in accordance with relevant laws regarding using a father's surname. The individual affirms the statements in the affidavit are true and the document is signed and notarized.

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AJ Santos
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322 views1 page

Affidavit for Surname Use RA 9255

This document is an affidavit filed by an individual seeking to use their father's surname on their birth certificate. It details that the individual was born on a specific date in a particular place, and their birth was registered with identifying information. It further notes that documentation of their father's admission of paternity was also registered. The affidavit is being filed to update the individual's surname in accordance with relevant laws regarding using a father's surname. The individual affirms the statements in the affidavit are true and the document is signed and notarized.

Uploaded by

AJ Santos
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

REPUBLIC OF THE PHILIPPINES) Registry No.

__________
Province of Cam. Sur)
City of Naga )s.s.

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, Name of Affiant, of legal age, Civil Status, Filipino, and a resident


of Complete Address, after having been duly sworn to in accordance with
law, do hereby depose and state that:

1. I am seeking the use of the surname_____________________ in my


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

2. I was born on Date of Birth at Place of Birth.

3. My birth was recorded under Registry No. ______ on Date of


Registration.

4. The Affidavit of Admission of Paternity or the Private Handwritten


Instrument was recorded under Registry No. ____ on Date of Registration at
the LCRO/Philippine Foreign Service Post(PFSP) of ____________.

5. I am filing this Affidavit to Use the Surname of the Father at the


LCRO/PFSP of _____________ in accordance with RA 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.

IN WITNESS WHEREOF, I hereby affix my signature this ___ day of


______ 2020 at Naga City, Cam. Sur, Philippines.

_____________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of January


2020 at Naga City, [Link], Philippines. Affiant exhibited to me his/her
______________, bearing his/her photograph and signature, to prove to me
that he/she is the same person who signed and executed the foregoing
Affidavit.

Doc No. ____


Page No. ____
Book No. ____
Series of 2020

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