An Affidavit of Birth template is a document written by someone with personal knowledge about the birth and submitted to a Court, Government Organization, School/University, or other institution in order to verify or correct birth information.


Also known as Birth Affidavit, Affidavit of Birth Certificate, Affidavit of Live Birth, or Date of Birth Affidavit, Affidavit of Birth Date, Affidavit of Birthday.

Common situations where an individual might use an Affidavit of Birth include:

  • An incomplete or incorrect birth certificate
  • A birth certificate that has been destroyed or misplaced
  • Supplementary proof of birth information
  • To file an application for a new birth certificate

An Affidavit of Birth can be used as a substitute for a birth certificate in many cases. Such as; The birth record is incomplete, the affiant is unable to locate the complete birth record, the affiant nedds additional proof of birth when applying for a job or an official document, such as a visa, passport, or Green Card.


  • It must address the specific circumstances of the birth
  • Information identifying the Affiant, including name, birth date, and full address.
  • It must be written by someone with personal knowledge about the birth (it doesn’t necessarily needs to be a blood relative like like a parent or a grandparent, but could be anyone who was there when the birth happened, such as the doctor, midwife, nurse, or close family friend. Someone who is qualified to attest under oath to the circumstances surrounding subject's birth and state how he/she knows the details of the birth to be true.)
  • Information on the subject of the Affidavit, like their name, age, gender, and citizenship

If you have doubts or is unsure how to write the affidavit, you may request the help of a legal professional to review or create the document for you.

One of the requirements for an affidavit is that details of a person’s birth contained in it need to be truthful as otherwise, a person might face a penalty for perjury.

The details of a person’s birth contained in the affidavit need to be truthful as otherwise, the affiant could face a penalty for perjury. Also, the petitioner or their beneficiaries are not allowed to be affiants in an affidavit of birth.

Although witnesses for the affidavit are not required, this document needs to be notarized before it can be used as an official substitute for a birth certificate.

The sample below can be edited or modified to fit your especific needs.


I, _________________, (Affiant’s Name) being duly sworn, hereby affirm and state under oath that:

I live at _________________________________________(Affiant’s complete address)
I was born in ___________________ (Affiant’s birth city, state and country) on ________________ (Affiant’s birth date), and I am ________________(Relationship to the Subject of the affidavit).

I affirm that I have direct personal knowledge about the birth of ________________ (Subject’s full name) who was born in ______________________ (birth city, state and country) to ________________________(Mother's First and Last Name) and (Father's First and Last Name). I have personal knowledge of the event and circumstances concerning the birth of because __________________________________________________________(state how you are aware of the birth and birth date).

I am giving this sworn statement because following numerous unsuccessful attempts to locate a birth certificate for ______________no birth record/certificate exists.

I solemnly swear (affirm) that the above statement is true and correct to the best of my knowledge and belief. I understand giving false testimony under oath in connection with an immigration application is a federal criminal offense that can attract severe terms of imprisonment.

_______________________   Date: ____/____/20____
Affiant’s full name

Affiant’s Signature

I certify under PENALTY OF PERJURY under the laws of the state of _________________ that foregoing paragraph is true and correct.

Identifying Document Submitted:

Type: ____________________________________________________

Date of Issuance/Expiration: __________________________________

Document Number: _________________________________________

State of _____________________________________________

County of ___________________________________________

Subscribed and Sworn to (affirmed) before me this _______ day of ________ , 20_______

WITNESS my hand and official seal

__________________________________ (Notary Seal)

Notary Public Full Name and signature

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