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Affidavit of Birth Template
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Affidavit of Birth Template
This Affidavit of Birth (the “Affidavit”) is made on [Date] by:
Affiant: [Full Name], date of birth: [DOB] (optional), address: [Address], phone/email: [Contact].
Relationship to Person Named Below: ☐ Parent ☐ Grandparent ☐ Relative ☐ Family friend ☐ Other: [Explain]
Person Whose Birth Is Being Verified: [Full Name at Birth]
Current Legal Name (If Different): [Name]
Date of Birth: [Date]
Place of Birth: [City, County/Province, State, Country]
Parents: [Parent 1 Full Name] and [Parent 2 Full Name] (if known)
1. Purpose
1.1 I am making this Affidavit to confirm the birth details of the person named above for: ☐ identification ☐ benefits ☐ school ☐ immigration ☐ other: [Purpose].
2. Basis of Knowledge
2.1 I have personal knowledge of the birth because:
☐ I am the parent
☐ I was present at or shortly after the birth
☐ I lived with the family at the time
☐ I learned these facts from reliable family records and long-term knowledge
☐ Other: [Explain]
3. Birth Details
3.1 The person named above was born on [Date] in [Place].
3.2 The person’s name at birth was: [Name at Birth].
3.3 Parents’ names (to the best of my knowledge):
Parent 1: [Name]
Parent 2: [Name]
3.4 Hospital/Midwife/Facility (If Known): [Name]
3.5 Birth Weight/Other Details (Optional): [Details].
4. Birth Certificate Status (Optional)
4.1 Birth certificate is: ☐ not available ☐ delayed ☐ incorrect/incomplete ☐ other: [Explain].
4.2 Steps taken to obtain/verify it (optional): [Describe briefly].
5. Supporting Documents (Attach as Available)
5.1 ☐ Hospital/medical record excerpt
5.2 ☐ Baptismal/church record
5.3 ☐ Early school record
5.4 ☐ Family record (Bible entry, etc.)
5.5 ☐ Government record/census excerpt
5.6 ☐ Photo ID of affiant
5.7 ☐ Other: [List]
6. Statement Under Oath
6.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.
Signatures
Affiant: [Full Name]
Date: [Date]
Signature: ___________________________
Witnesses (If Required)
Witness Name: [Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (If Required)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________
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Affidavit of Birth Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
AFFIDAVIT OF BIRTH TEMPLATE FAQ
What is an affidavit of birth?
An Affidavit of Birth is a sworn statement confirming a person’s birth details — such as full name at birth, date and place of birth, and parent information. It is sometimes used to support an application when a birth certificate is unavailable, delayed, or requires secondary evidence.
Who can sign it?
Often a parent, older relative, or another person with personal knowledge of the birth signs it. Some agencies accept affidavits from two people who knew the family at the time. Requirements vary, so this template includes flexible options.
What information is included?
Common fields include: the person’s name, date and place of birth, parents’ names, and the affiant’s relationship and basis of knowledge. This template also includes an optional section explaining why a birth certificate is not available.
Do you need notarization?
Often yes. Many agencies require notarization for affidavits. This template includes notarization and an optional witness section.
What documents can support it?
Examples include hospital records, baptismal records, early school records, family Bible entries, census records, or government letters. This template includes an attachments checklist.
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