LEGAL FORM: Affidavit to Use the Surname of the Father

REPUBLIC OF THE PHILIPPINES]

CITY OF MANILA     ]S.S.

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, MARIA CLARA, of legal age, Filipino citizen, and a resident of Sampaloc, Manila, after having been duly sworn to an oath in accordance with law, hereby depose and say, that:

1.      I am the mother of MARIA ANN CLARA DELA CRUZ who was born on September 29, 2018 at Sampaloc, Manila;

2.      I am seeking to use the surname “DELA CRUZ” in the Certificate of Live Birth of MARIA ANN CLARA DELA CRUZ, pursuant to RA 9255, who is my child with Juan Dela Cruz;

3.      I am filing this Affidavit to Use the Surname of the Father (AUSF) at the Local Civil Registrar of Iligan City, Philippines in accordance with R.A. No. 9255 and the Revised Implementing Rules and Regulations;

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

5.       I am executing this affidavit to attest to the truth of the foregoing facts and for whatever legal purpose this may serve and in compliance with the provision of R.A. No. 9255 and related rules and regulations.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at Manila, Philippines.

MARIA CLARA

Affiant

SUBSCRIBED AND SWORN TO before me this _____________, at Manila, Philippines.

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Series of 2019.