Affidavit of Birth Sample


I [your mother’s full name], being duly sworn, hereby affirm and state under oath that:

1.            I live at [your mother’s complete address]

2.            I was born in [your mother’s birth city/town, state/province and country] on [your mother’s birth date], and I am the mother of [your full name].

3.            I am married to [your father’s complete name].  We have been married since [marriage date].

4.            [Your full name] was born on [your birth date], to me and my spouse, [your father’s name].  [your full name] was born in [your birth city/town, state/province and country].

5.            I gave birth to [your full name] and I am giving this sworn statement because no birth certificate/record exists for my [daughter/son] following numerous unsuccessful attempts by my husband and I at locating a birth certificate for our child.

6.            I solemnly swear (affirm) that the above statement is true and correct to the best of my knowledge and belief.


[Print your mother’s full name]                       [Date]

Mother’s Signature

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

Identifying Document Submitted (Type of Document, Date of Issuance/Expiration, Document Number)

Signature of Notary            Place (City & State)


The contents of the affidavit will depend upon the facts of the case. This sample affidavit of birth is just a general guide. Giving false testimony under oath in connection with an immigration application is a federal criminal offense that can attract severe terms of imprisonment (18 U.S.C. § 154). For legal advice in a specific case consult a competent immigration attorney.

If you have questions about the right evidence to prove eligibility for an immigration benefit contact us at 702-423-2721 or via the Contact Us form to request a confidential  immigration consultation.



Published by

Goodin Law P.A.

Goodin Law (A Professional Association) is a Las Vegas immigration law firm founded by attorney Gary David Goodin, a Las Vegas immigration attorney providing legal services in green card and US citizenship cases. Goodin Law P.A. offers services for marriage green cards, k1 visas, naturalization, citizenship and employment based visas. Attorney Goodin is a member of The Florida Bar and the American Immigration Lawyers Association (Nevada and Washington DC chapters) and is authorized to practice immigration law in all fifty states.

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