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): ___________________