Birth Certificate Affidavit

Birth Certificate Affidavit

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HomeUS Visa & ImmigrationBirth Certificate Affidavit

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 2022 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 2022 in the town/city of [name of city], [country].
  • We got married on 2022 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.
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