Affidavit To Use The Surname of The Father: Doc. No. - Page No. - Book No. - Series of
Affidavit To Use The Surname of The Father: Doc. No. - Page No. - Book No. - Series of
1
(Revised March 2016)
___________________________) Registry Number: __________________
___________________________) SS
Cabuenas
1. I am seeking to use the surname ___________________________ in:
a) my Certificate of Live Birth/Report of Birth, pursuant to R.A. No. 9255 and its
Revised IRR.
4. The Affidavit of Admission of Paternity or the Private Handwritten Instrument was recorded
under Registry No. ___________________________ on _______________________ at the
(Registry Number) (Date of Registration)
Local Civil Registry Office (LCRO) / Philippine Foreign Service Post (PFSP) of
Talisay City Cebu Philippines
______________________________________________________________ (if applicable).
(City/Municipality) (Province) (Country/State)
6. I hereby certify that the statements made herein are true and correct to the best of my
knowledge and belief.
___________________________
Signature over Printed Name of Affiant
___________________________
Signature over Printed Name of the
Administering Officer
Doc. No. ________
Page No. _______
Book No. ________
Series of ________