Birth Certificate Affidavit

I, , residing at , do hereby solemnly affirm and declare as follows:

1. That I am the of , whose birth details are to be recorded.
2. That was born on at .
3. The father's name is and mother's name is .
4. My relationship with the child is .
5. The facts stated above are true and correct to the best of my knowledge and belief.

Verification

I, , hereby verify that the contents of this affidavit are true and correct.