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Affidavit To Use The Surname of The Father: Doc. No. - Page No. - Book No. - Series of

1. Aljunito Lamdagan Cabuenas seeks to use the surname "Cabuenas" for the birth certificate of his daughter Aljanedra Hope Cabajar Cabuenas. 2. Aljanedra Hope Cabajar Cabuenas was born on December 11, 2020 in Talisay City, Cebu, Philippines. 3. Aljunito Lamdagan Cabuenas is filing this affidavit at the Local Civil Registry Office of Talisay City, Cebu, Philippines to use the surname "Cabuenas" in accordance with RA 9255 and its revised implementing rules and regulations.

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0% found this document useful (0 votes)
164 views1 page

Affidavit To Use The Surname of The Father: Doc. No. - Page No. - Book No. - Series of

1. Aljunito Lamdagan Cabuenas seeks to use the surname "Cabuenas" for the birth certificate of his daughter Aljanedra Hope Cabajar Cabuenas. 2. Aljanedra Hope Cabajar Cabuenas was born on December 11, 2020 in Talisay City, Cebu, Philippines. 3. Aljunito Lamdagan Cabuenas is filing this affidavit at the Local Civil Registry Office of Talisay City, Cebu, Philippines to use the surname "Cabuenas" in accordance with RA 9255 and its revised implementing rules and regulations.

Uploaded by

Kem Paulo Que
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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R.A. No. 9255 Form No.

1
(Revised March 2016)
___________________________) Registry Number: __________________
___________________________) SS

AFFIDAVIT TO USE THE SURNAME OF THE FATHER


Aljunito Lamdagan Cabuenas
I, ________________________________, Filipino
_____________________, Singlee
__________, 28
______
Affiant’s Name Citizenship Civil Status age
years old, a Lagtang, Talisay City, Cebu, Philippines
resident of _______________________________________________________
Complete Address
after having been duly sworn to in accordance with law, do hereby declare that:

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.

b) Aljanedra Hope Cabajar Cabuenas


the Certificate of Live Birth/Report of Birth of _______________________________
X (Complete Name of Child)
who is my Daughter
____________________________________, pursuant to R.A. No. 9255
(Relationship of the Affiant to the Child)
and its Revised IRR.
Deecember 11, 2020
2. I/He/She was born on _________________ Talisay City Cebu Philippines
at ___________________________________.
(Date of Birth) (City/Municipality) (Province/State) (Country)
3. My/The birth was recorded under Registry No. _______________ on _________________,
(Registry Number) (Date of Registration)
(if applicable).

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)

5. I am filing this AUSF at the LCRO / PFSP of ______________________________________


Talisay City Cebu Philippines

(City/Municipality) (Province) (Country)


In accordance with 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

SUBSCRIBED AND SWORN to before me this ________ day of _______________ in


the city/municipality of _______________________________________, affiant exhibiting
his/her ____________________ 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.

___________________________
Signature over Printed Name of the
Administering Officer
Doc. No. ________
Page No. _______
Book No. ________
Series of ________

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