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    Affidavit of Explanation - Change of Name - Mary Rose Balajadia

    Uploaded by

    Vanessa Mallari
    1. Mary Rose Estacio Balajadia gave birth to a child, Nathania Eimery Balajadia Sua, on February 14, 2020 at the Mexico Community Hospital in Mexico, Pampanga. 2. She filled out the certificate of live birth form naming the child's father, who she was unmarried to at the time, as the last name. 3. She is executing an affidavit to request changing the child's last name to her own last name, Balajadia, since the child was born out of wedlock.

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    Affidavit of Explanation - Change of Name - Mary Rose Balajadia

    Uploaded by

    Vanessa Mallari
    146 views1 page
    1. Mary Rose Estacio Balajadia gave birth to a child, Nathania Eimery Balajadia Sua, on February 14, 2020 at the Mexico Community Hospital in Mexico, Pampanga. 2. She filled out the certificate of live birth form naming the child's father, who she was unmarried to at the time, as the last name. 3. She is executing an affidavit to request changing the child's last name to her own last name, Balajadia, since the child was born out of wedlock.

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    Affidavit of Explanation - change of name_Mary Rose Balajadia

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    1. Mary Rose Estacio Balajadia gave birth to a child, Nathania Eimery Balajadia Sua, on February 14, 2020 at the Mexico Community Hospital in Mexico, Pampanga. 2. She filled out the certificate of live birth form naming the child's father, who she was unmarried to at the time, as the last name. 3. She is executing an affidavit to request changing the child's last name to her own last name, Balajadia, since the child was born out of wedlock.

    Copyright:

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

    Affidavit of Explanation - Change of Name - Mary Rose Balajadia

    Uploaded by

    Vanessa Mallari
    1. Mary Rose Estacio Balajadia gave birth to a child, Nathania Eimery Balajadia Sua, on February 14, 2020 at the Mexico Community Hospital in Mexico, Pampanga. 2. She filled out the certificate of live birth form naming the child's father, who she was unmarried to at the time, as the last name. 3. She is executing an affidavit to request changing the child's last name to her own last name, Balajadia, since the child was born out of wedlock.

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    © 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)

    __________________________________) S.S.

    AFFIDAVIT OF EXPLANATION

    I, MARY ROSE ESTACIO BALAJADIA, of legal age, single, Filipino and a


    resident of #214 Sta. Lucia, Santa Ana, Pampanga, after being sworn in accordance
    with law, hereby depose and state that –

    1. On 14 February 2020, I gave birth to a child at the Mexico Community


    Hospital, Mexico, Pampanga;

    2. On said date, the hospital assisted in the preparation of the certificate of


    live birth of my child;

    3. I filled up the information required in the Certificate of Live Birth form


    and named my child Nathania Eimery Balajadia Sua, the last name being the
    surname of her biological father;

    4. However, since my child’s biological father and I were not married at the
    time of my child’s birth, I decided to change my child’s last name to Balajadia;

    5. I am executing this affidavit to inform the Mexico Community Hospital of


    the fact that my child is born out of wedlock and thus request that my child’s last
    name to be changed to Balajadia;

    6. Finally, I am executing this affidavit to attest the truth and veracity of


    the foregoing statements and for all legal intents and purposes it may serve.

    7. Affiant sayeth naught.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________


    2020 at ____________, Philippines.

    MARY ROSE ESTACIO BALAJADIA


    Affiant

    ACKNOWLEDGMENT

    REPUBLIC OF THE PHILIPPINES)


    ) S.S

    BEFORE ME, a Notary Public in and favor ______, personally appeared


    _________, with __________ issued on ________ as competent proof of identify, known to
    me and to me known to be the same person who executed the foregoing instrument
    and acknowledged before me as his free and voluntary act and deed.

    WITNESS MY HAND AND SEAL, this _______ day of 2020.

    Doc. No. ____;


    Page No. ____’
    Book No. ____;
    Series of 2020.

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