AFFIDAVIT: CONSENT TO TRAVEL

REPUBLIC OF THE PHILIPPINES )

Consulate General of the Philippines ) s.s.
New York, New York )

AFFIDAVIT OF SUPPORT AND CONSENT

WE/I ________________________________________________, __________

citizens, of legal age, single/married to __________________________________ and
resident of _________________________________________________________,
after having duly sworn in accordance with law, voluntarily depose and say:

1. We are/ I am the father/mother of minor(s)

NAME AGE

2. It is our/my desire for said child to travel to the ___________________________

(specify destination);

3. That said minor(s) will be accompanied by (name) ________________________

his/ her/ their______________________(relationship of companion to the minor);

4. That though the minor’s father/mother is not here at present, I am giving consent
to said minor’s travel in as much as (check applicable box):
□ 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.)
□ (Other)_____________________________________________________
___________________________________________________________
___ ___________________________________(state appropriate reason)

5. We / I hereby give our/my consent to said minor’s trip and assume any financial
obligations that may be incurred in the course of said travel and stay in
_____________________________ (specify destination).

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

the City of New York.

____________________________ ______________________________
FATHER MOTHER