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.