COLB Municipal Form No. 102

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AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION OF PATERNITY

(For births before 3 August 1988) (For births on or after 3 August 1988)

I/We, and ,
of legal age, am/are the natural mother and/or father of , who was
born on at .

I am / We are executing this affidavit to attest to the truthfulness of the foregoing statements and for purposes of
acknowledging my/our child.

(Signature Over Printed Name of Father) (Signature Over Printed Name of Mother)

SUBSCRIBED AND SWORN to before me this _______ day of _________________________, _________ by


_________________________________ and __________________________________, who exhibited to me his/her
CTC/valid ID ______________________________________ issued on ______________________________ at
_________________________________________.

Signature of the Administering Officer Position / Title / Designation

Name in Print Address

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH


(To be accomplished by the hospital/clinic administrator, father, mother, or guardian or the person himself if 18 years old or over.)

I____________________________________________, of legal age, single/married/divorced/widow/widower, with


residence and postal address at________________________________________________________________________
_________________________________after having been duly sworn in accordance with law, do hereby depose and say:
1. That I am the applicant for the delayed registration of:

my birth in __________________________________________ on __________________________.

the birth of __________________________________ who was born in ________________________


__________________________ on ____________________________.

2. That I/he/she was attended at birth by _____________________________________________ who resides at


_____________________________________________________________________________.

3. That I am/he/she is a citizen of _________________________________________.

4. That my/his/here parents were married on ________________________ at _____________________


________________________________________________.

not married but I/he/she was acknowledged/not acknowledged by my/his/her


father whose name is _____________________________________.
ggggg
5. That the reason for the delay in registering my/his/her birth was ______________________________________
_________________________________________________________________.
6. (For the applicant only) That I am married to ___________________________________.

(If the applicant is other than the document owner) That I am the ___________________ of the said person.

7. That I am executing this affidavit to attest to the truthfulness of the foregoing statements for all legal intents and purposes.

In truth whereof, I have affixed my signature below this ______ day of ________________________________
_________________________________________ at ________________________________________, Philippines.

(Signature Over Printed Name of Affiant)

SUBSCRIBED AND SWORN to before me this _______ day of _________________________, __________ at


_________________________________________________, Philippines, affiant who exhibited to me his/her CTC/valid ID
_________________ issued on ____________________________ at _________________________________________.

Signature of the Administering Officer Position / Title / Designation

Name in Print Address

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