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    Affidavit To Use The Surname of The Father

    Uploaded by

    Aidalyn Mendoza
    This document is an affidavit allowing an individual to use their father's surname. It states that the individual wishes to change the surname on their birth certificate and/or their child's birth certificate to their father's surname. It provides details of when and where the individual and child were born. It also references the affidavit of paternity that was previously filed and certified that the statements in this new affidavit are true.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Affidavit To Use The Surname of The Father

    Uploaded by

    Aidalyn Mendoza
    97 views1 page
    This document is an affidavit allowing an individual to use their father's surname. It states that the individual wishes to change the surname on their birth certificate and/or their child's birth certificate to their father's surname. It provides details of when and where the individual and child were born. It also references the affidavit of paternity that was previously filed and certified that the statements in this new affidavit are true.

    Original Description:

    use the surname

    Original Title

    AUSF- BLANK

    Copyright

    © © All Rights Reserved

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    This document is an affidavit allowing an individual to use their father's surname. It states that the individual wishes to change the surname on their birth certificate and/or their child's birth certificate to their father's surname. It provides details of when and where the individual and child were born. It also references the affidavit of paternity that was previously filed and certified that the statements in this new affidavit are true.

    Copyright:

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

    Affidavit To Use The Surname of The Father

    Uploaded by

    Aidalyn Mendoza
    This document is an affidavit allowing an individual to use their father's surname. It states that the individual wishes to change the surname on their birth certificate and/or their child's birth certificate to their father's surname. It provides details of when and where the individual and child were born. It also references the affidavit of paternity that was previously filed and certified that the statements in this new affidavit are true.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    R.A. NO. 9255 Form No.

    1
    Registry Number __________________
    Republic of the Philippines )
    Province of Cavite )S.S.
    Trece Martires City )

    AFFIDAVIT TO USE THE SURNAME OF THE FATHER

    I, _________________, ______ years of age, Filipino citizen, single, ___________, after having
    been duly sworn to in accordance with law, do hereby declare that:

    1. I am seeking to use the surname ____________ in:

    a) my Certificate of Live Birth/Report of Birth, pursuant to R.A. 9255 and its Revised IRR.
    b) the Certificate of Live Birth/Report Birth of ______________________
    √
    who is my ____________________.

    2. He/She was born on ___________________ at __________, Philippines.

    3. The birth was recorded under Registry Number _________ on __________;

    4. The Affidavit of Admission of Paternity of the Private Handwritten instrument was recorded
    under Registry No. (______________) on (_________) at the Local Civil Registry Office
    (LCRO)/Philippine Foreign Service Post (PFSP) Trece Martries City, Cavite, Philippines;

    5. I am filling this AUSF at the LCRO/PFSP of Trece Martires City, Cavite, Philippines, in
    accordance with R.A. 9255 and Its Revised Implementing Rule 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 on this 6 th day of December 2021 at Trece
    Martires City, Cavite, Philippines.

    _________________________
    Signature Over Printed name of Affiant

    SUBSCRIBED AND SWORN to before me on this 6th day of December 2021 in Trece Martires City,
    Cavite, Philippines, affiant exhibiting her PhilHealth Identification bearing the number ____________
    competent proof of her identity.

    I certify that I personally examined the affiant and that she voluntarily executed the foregoing
    affidavit and understood the contents thereof.

    Doc. No. : ______


    Page No. : ______
    Book No. : ______
    Series of : 2021

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