AFFIDAVIT OF ADMISSION OF PATERNITY AND

CONSENT TO USE SURNAME OF FATHER

I, ______________________, a citizen of ______________, of legal

age and presently residing at ________________ after having been duly
sworn to in accordance with law, do hereby depose and state that:

1. I arrived in Hong Kong on _______________________ and I am

now a holder of ___________________________;( please state status of
stay in Hong Kong e.g. Employment via, unconditional stay, or right of
abode)

2. That I am presently employed at ________________________ as

____________________________;

3. That sometime in ______________, I met

_______________________, a Filipino national, with whom I later had a
relationship with;

4. That as a result of said relationship, she conceived and gave birth

to a child on _________________________ in ____________________
and we named the child _______________________________________;

5. That I am not legally married to Ms. _________________, the

mother of my child, in accordance with Philippine laws;

6. That I hereby admit under oath the paternity of

______________________; and

7. That I further acknowledge that I am the natural father of said

child and I am willing to give the child all rights as my own under the laws
of the Philippines, including the right to carry and use my surname in
accordance with Republic Act No. 9255 and other pertinent laws especially
pertaining to the provisions of the Family Code of the Philippines;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____ day of August 2014 in ______________________________.

Affiant

REPUBLIC OF THE PHILIPPINES )

CITY OF __________________ ) S. S.

SUBSCRlBED AND SWORN to before me this ______ day of 2014 in

______________________________, affiant exhibiting to me his
____________________________ with Identity Card No. _________ issued on
___________________ in _____________________________________.

Doc. No.
Page No.
Book No.
Series of 2014