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 minor’s
father/mother is not here present, I am giving consent to said minor’s 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 minor’s application for a Philippine passport. IN
WITNESS WHEREOF, I have hereunto set my hand this ___________ in the City of New
York ________________________________ ______________________________ NAME OF
ACCOMPANYING ADULT AFFIANT