REPUBLIC OF THE PHILIPPINES)

Quezon City
) SS.
AFFIDAVIT OF ACKNOWLEDGEMENT OF PATERNITY
AND CONSENT TO USE THE SURNAME OF FATHER
I, REYNALD TACAZON SUMABAT, of legal age, Filipino/US citizen, with
residence AND POSTAL address at No. 4-5TH Camarilla Street, Murphy, Cubao,
Quezon City, after being duly sworn in accordance with law, do hereby depose and
state:
1. That I am the biological father of the minor / child TREB CARLOS FELIX
who was born on May 15, 2008 at Quirino Medical Center in Quezon City;
2. That at the time of the birth of the said minor, I was not married and still
not married to his biological mother, JOANNE KRISTINE MEA FELIX.
3. That I hereby acknowledge my paternity / filiation of the minor/child TREB
CARLOS FELIX.
4. That I am giving my consent for the minor/child to use my surname and
that the same be reflected in his birth certificate and be known from TREB
CARLOS FELIX to TREB CARLOS FELIX SUMABAT;
5. That I am executing this affidavit to the truth of the foregoing facts and for
whatever purpose it may serve
IN WITNESS WHEREOF, I have hereunto affixed my signature this 11 TH day of
May 2015 at Quezon City.

RIC E. FAJARDO
Affiant
SUBSCRIBED AND SWORN TO before me this 11 th day of May 2015 at Quezon
City. Affiant exhibited to me his/her ID as indicated above.
Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of 2015.