REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC : S.S.

MUNICIPALITY OF BAMBAN )

AFFIDAVIT OF CUSTODY
I, _________________________, of legal age, Filipino, single, with residence
and postal address at _________________________, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and say:

THAT—

1. I am the legal and biological mother of minor child

_________________________, who was born on December 21, 2001,
presently residing at Brgy. Cut-Cut 2nd, Capas, Tarlac 2315,
Philippines, a copy of his Certificate of Live Birth is hereto attached
as Annex “A” to form an integral part hereof;

2. I have the legal custody of minor child _________________________, and

have the right to take my child to Hongkong, Singapore, Malaysia
and other countries and back to the Philippines;

3. I am executing this Affidavit of Custody to attest to the truth of all

the foregoing;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 3 rd

day of April 2012 at Bamban, Tarlac 2317, Philippines.

_________________________
Affiant
SSS: _________________________

SUBSCRIBED AND SWORN to before me this 3rd day of April 2012 at

Bamban, Tarlac, Philippines, affiant exhibited to me her positive identification
duly noted above below her name and signature, known to me and to me
known to be the same person who executed foregoing Affidavit of Non-Tenancy
and acknowledged to me that the same is her free act and deed and that she
voluntary executed the same and understood all the contents thereof.

WITNESS MY HAND AND SEAL.

Doc. No. 36;

Page No. 08;
Book No. X;
Series of 2012.