FOREIGN SERVICE OF THE PHILIPPINES )

CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES) S.S.

HONOLULU, HAWAII, U.S.A.

Affidavit of Acknowledgment of Paternity and to Usethe Surname of Father

I, __________________________________________________, of

legal age, single/married, Filipino citizen and a resident of

_____________________________________________________________

after having been duly sworn to in accordance with law do hereby depose

and say:

1. That I am the biological father of the minor/child,

______________________________________________________,

who was born on ______________________________ in

________________________________;

2. That at the time of the birth of said minor/child, I was not legally

married to his/her biological mother;

3. That I hereby acknowledge my paternity / filiation of the minor / child,

____________________;

4. That I am giving my consent for the minor/child to use my surname

and that the same be reflected in his/her birth certificate;

5. That I am executing this affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of

______________ 20, ____ in the City and County of Honolulu, Hawaii, USA.

_______________________________ (Printed Name and Signature of Father)