AFFIDAVIT
I, <mother's name>, wife of <father's name>, solemnly state and confirm hereunder:

1. I was born in <city, state, country> on <mother's date of birth>.
2. I got married to <father's name> on <date of marriage>.
3. I am the mother of <your name> and <father's name> is his/her father.
4. <your name> was born on <your date of birth> at <your time of birth> in <city, state, country>.
5. I have known <your name> since his/her birth.

Signature:

Date:

Place:

N O T A R Y