Affidavit of Birth Form

An Affidavit of Birth is a document that acts as a written solemn oath that a birth occurred. It lists vital information including the day, time, and location of the birth. It may be completed by a medical professional who witnessed a birth in the event that a birth certificate is lost. Once notarized, this form may help someone prove citizenship or even apply for a new birth certificate. A parent may also complete an Affidavit of Birth for their child.

What is a birth affidavit?

An Affidavit of Birth is used to verify someone's birth information, such as date and time of birth, place of birth, and parent information. It may be used if someone has an incomplete birth record, if their birth certificate has been lost, or if they are not from the United States. Birth records are used for applying for citizenship, jobs, and more.

In this type of document, an individual will make a sworn statement detailing their birth record information. This statement is created under penalty of perjury, so it must be truthful and accurate. An Affidavit of Birth must be created by a person who has first-hand knowledge of the person’s birth.  An example would be an older blood relative who was present at your birth or the doctor or midwife who delivered you. The affidavit of birth must specify how that person who is swearing under oath the details of your birth knows that information.

The form must be signed, dated, and notarized by a notary public before it is complete. The state and county that this form was completed in should also be included somewhere in the document.

Other Names

  • Affidavit of Live Birth
  • Affidavit of Birth Certificate
  • Date of Birth Affidavit
  • DS 10

When should you use a birth affidavit?

You should use an affidavit of birth:

  • If you have an incomplete birth record
  • You cannot locate an acceptable birth certificate
  • You need additional proof of your birth to apply for a job or other official purpose

Who can write an affidavit

The person who writes the affidavit is called the affiant.  The affiant is often a relative of the person who needs a birth record.  The affiant does not need to be a U.S. citizen. It is common for parents to write affidavits for their children.

If the affidavit of birth is being used for permanent resident status in the United States, the affiant cannot also be submitting their application for permanent resident status at the same time.

Using a birth affidavit to apply for a new passport

If you are applying for a new U.S. passport with a DS-11 form at a U.S. passport agency, you will need to provide a lot of information and proof of your identity and citizenship.  U.S. passport applications require official proof of citizenship, which is generally your birth certificate or paperwork that documents your naturalization. If you are an applicant whose birth certificate does not exist, you will be required to fill out a DS-10 Birth Affidavit Passport Form.  You can obtain this form from the U.S. Department of State.

The DS-10 Form requires a written statement by the relevant authority that no birth certificate or record exists and a photocopy of boths sides of that person’s identification.  Any person who is submitting a birth affidavit must have personal knowledge about the facts related to the applicant’s birth in the United States.

A form DS-10 is considered a secondary type of citizenship confirmation.  It must also be submitted with other appropriate early public records. It should only be used when the standard birth certificate is unavailable.

A DS-10 Birth Affidavit Passport Form should be submitted with all other required documents to an acceptance agent.  This includes:

  • Photocopy of applicant’s driver's license, front and back
  • Early public records such as Census records, family Bible records, doctor’s records, and Baptismal certificates and hospital certificates

When you are filling out the actual DS-10 form, you will need to complete all sections.   The top part of the form is your individual information, such as applicant's date of birth, place of birth, current home address.  If any item is not applicable, you should write “N/A.”

The middle section of the form should be filled out by your reference.  This will contain a detailed statement including the date/time/location of applicant's birth, individuals present, and any other first-hand knowledge of the event or how the reference obtained knowledge of the event.  The reference must also list the applicant's birth parents and their relationship to the applicant and/or birth parents.

The bottom section of the form is where you should have the form signed and notarized.  Be sure to sign it in front of a notary who must stamp the form with his or her valid notary stamp.

The DS-10 form contains a Paperwork Reduction Act Statement, which states that "Public reporting burden for this collection of information is estimated to average 40 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documentation required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Legal Affairs and Law Enforcement Liaison, Attn: Passport Forms Officer, 44132 Mercure Cir., P.O. Box 1227, Sterling, Virginia 20166-1227"

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Sample Affidavit of Birth

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