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Petitioner.3rd Person - Admission For CDCLAA

This document provides a template for an affidavit of admission of simulation of birth to be used during the CDCLAA stage of an administrative adoption case. The template outlines the information that should be included in the affidavit, such as how the child came into the care of the petitioner, the child's true identity and biological parents, and the purpose of admitting the simulation of birth record to meet requirements under the CDCLAA law. The affidavit must be notarized and executed by the petitioner(s).

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AlyssaCabrera
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641 views

Petitioner.3rd Person - Admission For CDCLAA

This document provides a template for an affidavit of admission of simulation of birth to be used during the CDCLAA stage of an administrative adoption case. The template outlines the information that should be included in the affidavit, such as how the child came into the care of the petitioner, the child's true identity and biological parents, and the purpose of admitting the simulation of birth record to meet requirements under the CDCLAA law. The affidavit must be notarized and executed by the petitioner(s).

Uploaded by

AlyssaCabrera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Instruction: Kindly use this template as guide in preparing the Affidavit to be

executed by the petitioner/s or with the 3 rd person during the CDCLAA stage. In
case, petitioners are spouses, please prepare a joint affidavit. You may enhance it to
include additional information/s that is/are relevant to the case.

REPUBLIC OF THE PHILIPPINES)


Province of____________________) S.S.
City/Municipality of_____________)
x---------------------------------------x

AFFIDAVIT OF ADMISSION OF SIMULATION OF BIRTH

I/We, ______________(name of affiant/s)__________________, Filipino, of legal age, single/married,


and a resident/s of ___________(address of affiant/s)____________, after having been duly sworn in
accordance with law, hereby depose and state:

1. That on or about ___________(date ) , a child__month/year(s) old was left/ given/


referred to my/our care and custody by (name of person/s to who entrusted the child). Since
then I/We personally raised him/her as my/our own son/daughter. I/We provided him/her with
all the material and emotional needs;

(other circumstances as to how the child came to the custody of the affiant/s and how the
child is treated must be stated;)

2. That in my/our ardent desire to ensure that the care for the child will be permanent, I/we
registered him/her as my/our own child. I/We named him/her __________________, at the
Local Civil Registrar of ___________________ despite the fact that I/we am/are very much
aware of his/her true identity;

3. That in fact, her biological parents are _____________________________(state the name


of the parents) who is/are personally known to us or to __(name of 3rd person)__. (Child) is
born on ____________ at________________.

(other factual information about the child’s true identity i.e. siblings, place of birth must be
stated;)

4. That I/We am/are executing this Affidavit to attest to the truth of the foregoing facts and for
the purpose of admitting the fact that I/we caused the simulation of birth record of
______(name of child)__________ to make it appear that he/she was born to me/us, the
known parent/s ___________, but his her real parents are _________________________
who must execute the Deed of Voluntary Commitment as required under the CDCLAA Law or
RA 9523 which is a basic requirement in Administrative Adoption under RA 11222;

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____th day of ____________
20___ at ____________, Philippines.

____________( Signature)__________ ______ (Signature________


(Affiant’s Printed Name) (Affiant’s Printed Name)

____________( Signature)__________
(Affiant’s Printed Name)
(3rd Person, if applicable)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for


_________(City/Province)____________ this ____th day of ____________ 20___. Affiant personally
came and appeared with _____________(Competent Evidence of Identity)______ issued by the
_________(Government Agency)______ on ___(date)__ at ________(place)_________, bearing his
photograph and signature, known to me as the same person who personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of said
instrument.

Atty ___________________________________________
Notary Public
Doc. No. ____ Commission Serial No. ____________________________
Page No. ____ Notary Public for _______(Province/City)______________
Book No. ____ Until December 31, 20__
Series of 20__ Office: ______________(address)____________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ;
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__

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