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AFFIDAVIT OF BIRTH FACTS
I , __________________________ (name of the person preparing the Affidavit) after being sworn, do hereby depose and say that:
1. I am a citizen and national of __________(country) born on__________(place).
2. I have direct knowledge of the birth of _____________(person benefit the Affidavit is being prepared-“beneficiary’) as I am her ___________(reltionship with the person like mother, Uncle,Aunt etc).
3. ______________(beneficiary) was born on _________(date ofbirth) at ___________
(place of the birth including country)
4. ____________’s (name of the beneficiary’s) natural parents are _________________
the mother(name of the mother) and ______________father (name of the father).
5. This affidavit of Birth facts is being offered as the recorded birth Certificate of __________(name of the beneficiary).
6. It is my prayer that this Affidavit be accepted for this purpose.
Signature__________________
Name of the person
Date __________________1999.
STATE OF _________, CITY/COUNTY OF __________, TO WIT:
I HEREBY CERTIFY THAT on this ____ day of _______, 1999, before me, a
Notary Public of the aforesaid State and City/County, personally appeared
Mr. _________, known to me (or satisfactorily proven) to be the person
Whose name is subscribed to the foregoing instrument, who acknowledged that
he has executed it for the purposes therein set forth.
___________________________
Notary Public
My Commission expires:_____________________________