Republic of the Philippines….

)
City of Zamboanga….)

AFFIDAVIT OF CONSENT
I, IVY FLORENCE A. HAMSIRANI, Filipino, of legal age, married and a resident of
Sta. Maria, Zamboanga City, Philippines, having been duly sworn in accordance with law,
hereby depose and state:
1. That I am the mother of ARNOLD JR. A. HAMSIRANI, who is applying for a Student
Driver's Permit at the Land Transportation Office (LTO);
2. That I am giving my full consent to my said son in his application for a Student Driver's
Permit;
3. That there is no criminal case pending in court against him nor has he been charged of
subversion, rebellion or insurrection in any court of the Philippines;
4. That I am executing this affidavit to declare the truth of the foregoing facts as to my
undertaking to give consent to my son's application for Student Driver's Permit.

IN WITNESS WHEREOF, I have hereunto set our hands this ________ at Zamboanga City,
Philippines.

IVY FLORENCE A. HAMSIRANI

(Name of parent)

SUBSCRIBED AND SWORN TO before me this _________ at Zamboanga City, Philippines.