State of
County of
I, , residing at , social tax number , being duly sworn, testify and state as follows:
Reason for Affidavit. This Affidavit is being submitted because .
I further declare that , male, residing at (the "Applicant"), was born on , in the city of , County, State of .
I have known the Applicant since , and I possess knowledge of the Applicant's birth details because .
The Applicant's parents are:
Legal acknowledgment. I declare under penalty of perjury that the above information I gave is true and correct to the best of my knowledge. I understand that any false statements may have legal consequences.
This Affidavit was made on .
____________________________
(Place for signature)
Official Acknowledgment
Identifying document presented. The following document was provided by the Affiant for verification:
ID number: ;
Place of issue: ;
Issue date: ;
Expiration date: .
On , the Affiant listed above, who is not related to me, personally appeared before me and is known to me to be the person whose name is subscribed to and acknowledged that the Affiant executed the same for the uses and purposes therein contained. I have appropriately verified the identity of the Affiant by personally viewing the aforementioned identification document and matching photocopy.
State of
Acting in the country of
___________________________________
Place for signature
______________________________________
Passport agent's full legal name