FOREIGN SERVICE OF THE PHILIPPINES )

CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES) S.S.

HONOLULU, HAWAII, U.S.A. )

Affidavit of Consent
I, _______________________________, Filipino, of legal age,
single/married to __________________________________ and resident of
____________________________________________________________, after
having duly sworn to in accordance with law, voluntarily depose and say:

1. That I am the father/mother of minor(s) ___________________________

___________________________________________________________
____________________ who is/are ________________________ years
old;

2. That said minor(s) is/are applying for a Philippine passport in connection

with his/her forthcoming trip to the _______________________________;

3. That said minor(s) will be accompanied by his/her:

___________________________________________________________
(relationship and name of person accompanying minor(s));

4. That though the minors father/mother is not here present, I am giving

consent to said minors travel in as much as:
______ said father/mother has earlier voluntarily and freely given his/her
consent, with no condition imposed whatsoever, and requested that
said consent be relayed by me.
______ I have exclusive legal custody of minor (see attached divorce
decree / death certificate / etc.)
___________________________________________________________
________________________________________________________
(state appropriate reason)

5. That I assume responsibility for the issuance of the passport and for
allowing the trip of said minor and further assume any and all obligations
consequent thereto; and

6. That I am executing this Affidavit to attest to the truth of the above

statement in connection with said minors application for a Philippine
passport.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________

in the City of Honolulu.

________________________________
AFFIANT