P

A
Republic of the Philippines) G
City of Iloilo ) S.S. E
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AFFIDAVIT OF CONSENT

I, JENNIE LOU AMARANTE HUBAG, of legal age, Filipino, single, and resident of Rizal Street,
Pontevedra, Negros Occidental, Philippines, after having been duly sworn to in accordance with law,
hereby depose and say:

1. That I am the mother of MA. EMMA LUISA AMARANTE HUBAG, 12 years old, born on August
5, 2005, at Pontevedra, Negros Occidental;

2. That my child MA. EMMMA LUISA A. AMARANTE, is presently residing at Hedriana Street,
Barangay Anilao, Pavia, Iloilo, under the care and custody of my aunt FLOR P. HUBAG and as
her guardian; and

3. That I am giving full consent for my child to travel to Sydney, Australia and back to Iloilo City,
Philippines, with my aunt as her guardian, FLOR P. HUBAG, of legal age, Filipino and presently
residing at Hedriana Street, Barangay Anilao, Pavia, Iloilo, to participate in the dance
competition for the World Supremacy Battle representing the Philippines as member of the
(USADA Kidz) University of San Agustin Dance Arts Kids on October 8-16, 2018.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of May 2018, at Iloilo City,
Philippines.

JENNIE LOU A. HUBAG

Affiant

SUBSCRIBED AND SWORN TO Before me this ____ day of May, 2018 at Iloilo City, Affiant
exhibiting her ______ID No. ________ issued by the _____________, as her competent proof of identity,
bearing her signature and photograph.

I hereby certify that I have personally examined the Affiant and that I am satisfied and convinced
that she voluntarily executed and understood the content of her foregoing Affidavit.

Doc. No. _____;

Page No. ____;
Book No._____;
Series of 2018