I, [your mother's name], ___ years of age, currently residing at [address], hereby solemnly affirm and declare on oath that:

  • I am the deponent herein and a citizen of [country].
  • I was born on [date] at [place of birth].
  • I was married to [father's name] on [date] in [place of marriage].
  • On [date], I gave birth to our first child on [date], at our house at [address].
  • [Your name] was born on [date] in [place of birth]. I have the personal knowledge of his birth because I am his mother.
  • [Your name] full name at the time of birth was given as [Your full name].
  • [Your name] birth was registered later because it was not required at that time to register the birth of children.

I do hereby solemnly affirm that foregoing are true and correct statements.

Place: ______________

Date: __________________



[Notary Info and Seal]