Affidavit of Acknowledgment/Admission of Paternity

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Republic of the Philippines)

City of Cebu )S.S.


x-------------------------------------/

AFFIDAVIT OF ACKNOWLEDGMENT/ADMISSION OF PATERNITY

I, JAMES CLAUDE BOHOL CENIZA , of legal age, single, Filipino


Citizen, and currently residing at Fairlane Village Guadalapu Cebu City, Cebu
Philippines, after having been duly sworn to in accordance with law, hereby
depose and state that -

1. I am the biological father of Ethan Gabriel Rosalejos Ceniza who was


born on August 3, 2020 at Brgy. Lunang Hilongos Leyte Philippines.

2. The biological mother of the aforesaid child is Mary Jane Satintis


Rosalejos.

3. At the time of the birth of the said child, I was not married to Mary Jane
Satintis Rosalejos who is the biological mother;

4. I, being the father, hereby acknowledge and recognize the said child as
mine;

5. I am giving my consent for the said child to use my surname and for my
surname “ CENIZA” be reflected in the child’s Certificate of Live Birth;

6. I am executing this affidavit to attest to the truth of the foregoing facts,


and for having my name reflected as the father of the said child and to have
my surname “CENIZA” be used as the surname of my son; and for whatever
legal purposes that this affidavit may serve.

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


of__________________in Cebu City Philippines.

JAMES CLAUDE BOHOL CENIZA


( AFFIANT)

Subscribed and sworn to before me this___________in Cebu City


Philippines. Affiant showed to me his DRIVER’S LICENSE NO. H05-16-001565
as competent proof of his identity.

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