REPUBLIC OF THE PHILIPPINES

)
___________________________________ )S.S.
___________________________________ )

AFFIDAVIT OF SUPPORT
I,_________________________________________________________, and my
spouse, _________________________________________________________________,
daughter and son-in-law of _________________________________________________
citizen(s) of the _______________________________, of legal age(s), and resident(s) of
___________________________________________________________________, after
having been duly sworn to in accordance with law, do hereby depose and state:
That I am/we are willing and able to maintain and support our parent financially
and guarantee that she will not become a public charge or burden during her stay in the
United States.
IN WITNESS WHEREOF, I/we have hereunto set my/our hand this __________
day of _______________ 20_____ at ______________________.

___________________________________
DAUGHTER (Affiant)
___________________________________
AFFIANTS SPOUSE

SUBSCRIBED AND SWORN to before me this _______ day of ____________

at _____________________________.

Doc. No.: _________

Service No.: _______
Series of 20________
Fee Paid: _________
O.R. No.: _________