Following is a sample of birth certificate affidavit. The letter below is for reference only. Make changes to this as per your applicable situation.
You can also download the MS-Word Format of this Birth Certificate Affidavit Sample here.
We, [Father’s First Name] [Father’s Last Name] and [Mother’s First Name] [Mother’s Last Name], hereby depose and say:
- Our full and complete address is [street address with apartment or house number, town/city, state, postal zip code].
- That I, [Father’s First Name] [Father’s Last Name] was born on 2023 in the town/city of [city], [country].
- That I, [Mother’s First Name] [Mother’s Last Name] (Mother’s Maiden Name: Mother’s Maiden Name), was born on 2023 in the town/city of [name of city], [country].
- We got married on 2023 in the city of [name of city], [country].
- Child’s First Name] [Child’s Last Name] our daughter/ son, was born to us on the date at Location ( So and so Hospital, CITY).
- This affidavit is being submitted because the official record of birth is incomplete concerning [Child’s First Name] [Child’s Last Name].
_________________________
[Father’s First Name] [Father’s Last Name] and signature
_________________________
[Mother’s First Name] [Mother’s Last Name] and signature
Subscribed and Sworn to before
Me, this ____ day of __________,
[YEAR] at ______________________.
Disclaimer
This sample is provided for your convenience and reference purpose only.
