Republic of the Philippines)

City of Z A M B O A N G A ) S.S.

AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, ANTONIO M. DIAGBEL, of legal age, single, Filipino citizen, and

presently residing at Lumiyap, Divisoria, Zamboanga City, after having been
duly sworn to in accordance with law, do hereby depose and state:

1. That I am the biological father of ANABEL BUCOY ;

2. That my child ANABEL BUCOY was born on September 27, 2011 at

Sindangan Zamboanga del Norte;

3. That the facts of birth of my child were duly registered at the Office of the
Civil Registrar General, Zamboanga Del Norte;

4. That being the father of ANABEL BUCOY, I hereby acknowledge and

recognize ANABEL BUCOY as my child and legal heir;

5. That I am allowing my child ANABEL BUCOY to use my surname to be her

surname in his Certificate of Live Birth; and

6. That I execute this affidavit to attest to the truth of the above facts in
compliance with the provisions of Republic Act No. 9255.

IN WITNESS WHEREOF, I have hereunto set my hand on the date and place
hereinafter mentioned.

ANTONIO M. DIAGBEL
Affiant

SUBSCRIBED AND SWORN to before me on this ______ day of January,

2020 at Zamboanga City, Philippines. Affiant having exhibited to me his
____________ Id. No. ______________ issued on _____________________ issued in
Zamboanga City.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2020