I, _________________, of legal age, single/married/widow, Filipino citizen, and presently residing at _____________________, after having been duly sworn to in accordance with law, do hereby depose and say:
- That I am the biological father of _________________.
- That the biological mother of the child is _________________.
- That my child _________________ was born on __________ ____, _____ at _________________.
- That the facts of birth of my child were duly registered at the Office of the __________ Civil Registrar.
- That I, _________________ being the father of _________________, hereby acknowledged and recognized him as my child and legal heir.
- That I am allowing my child _________________ to use my surname _________________ to be his surname in his Certificate of Live Birth.
- That I execute this affidavit to attest to the truth of the above facts in compliance with the provisions of Republic Act No. 9255.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in ____________, _____________, Philippines.