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    Affidavit To Use The Surname of Father

    Uploaded by

    Jan Brian Bangcaya
    This 3 sentence summary provides the key details from the document: This document is an affidavit form where the affiant declares that they want to use the surname of the father on their birth certificate or their child's birth certificate according to RA 9255, and they swear that the statements made in the affidavit are true and correct to the best of their knowledge and belief. The affiant provides their personal details like name, age, address, date and place of birth, and registry number if applicable, and the affidavit is signed before and certified by the municipal civil registrar.

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

    Affidavit To Use The Surname of Father

    Uploaded by

    Jan Brian Bangcaya
    181 views1 page
    This 3 sentence summary provides the key details from the document: This document is an affidavit form where the affiant declares that they want to use the surname of the father on their birth certificate or their child's birth certificate according to RA 9255, and they swear that the statements made in the affidavit are true and correct to the best of their knowledge and belief. The affiant provides their personal details like name, age, address, date and place of birth, and registry number if applicable, and the affidavit is signed before and certified by the municipal civil registrar.

    Original Description:

    Format for Affidavit to use the surname of father

    Original Title

    AFFIDAVIT-TO-USE-THE-SURNAME-OF-FATHER

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    This 3 sentence summary provides the key details from the document: This document is an affidavit form where the affiant declares that they want to use the surname of the father on their birth certificate or their child's birth certificate according to RA 9255, and they swear that the statements made in the affidavit are true and correct to the best of their knowledge and belief. The affiant provides their personal details like name, age, address, date and place of birth, and registry number if applicable, and the affidavit is signed before and certified by the municipal civil registrar.

    Copyright:

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

    Affidavit To Use The Surname of Father

    Uploaded by

    Jan Brian Bangcaya
    This 3 sentence summary provides the key details from the document: This document is an affidavit form where the affiant declares that they want to use the surname of the father on their birth certificate or their child's birth certificate according to RA 9255, and they swear that the statements made in the affidavit are true and correct to the best of their knowledge and belief. The affiant provides their personal details like name, age, address, date and place of birth, and registry number if applicable, and the affidavit is signed before and certified by the municipal civil registrar.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    R.A. No. 9255 Form No.

    1
    (Revised March 2016)

    Registry Number________
    _______________________________)
    ________________________________)SS

    AFFIDAVIT TO USE THE SURNAME OF FATHER

    I,____________________________________,___________________, ___________________, ________________


    Affiant`s Citizenship Civil Status age
    years old, a resident of __________________________________________________________________________
    Complete address
    after having been duly sworn to accordance with law, hereby declare that.

    1. I am seeking to used the surname_________________________________________ in


    a. my Certificate of Live Birth/ Report of Birth, pursuant to R.A. No. 9255.
    b. the Certificate of Live birth/ Report of Birth of________________________________________
    (Complete Name of Child)
    who is my _________________________________________, pursuant R.A. No. 9255.
    (Relationship of the Affiance to the Child)
    2. I He/She was born on_________________________________at ____________________________________
    (Date of Birth) (Municipality)
    ______________________________________________________________________________________
    (Province) (Country)
    3. My/The birth was record under Registry No.________________on________________________( if applicable)
    (Registry No) (Date of Registration)

    4. The Public Document or the Private Handwritten Instrument was recorded under Registry No_________ on
    _________________________________________________________ at the Local Civil Registry Office (LCRO)/
    / Philippine
    (Date of Registration)
    Philippine Foreign Service Post(PFSP) of ____________________________________________ (if applicable).
    (Municipality) (Province) (Country)
    5. I am filing this AUSF at the LCRO/PFSP of_________________________________________ in accordance with
    (Municipality) (Province) (Country)

    R.A. No. 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.
    7. In witness whereof, I hereby affix my signature on this__________day of___________________, 20_______ at
    ______________________________________________________.

    _________________________________
    Signature over printed name of Affiant

    SUBSRIBED AND SWORN to before me this______day of___________________in the city/municipality of


    ____________________________affiant exhibiting his__________________________issued at
    _______________________________on_______________________. I certify that I personally examined the
    affiant and that he/she voluntarily executed the foregoing affidavit and understood the contents thereof.

    SHEILA S. LAGRIMAS
    Mun. Civil Registrar
    Doc. No._________________________
    Page No._________________________
    Book No._________________________
    Series of_________________________

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