REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ___________ ) S. S.
MUNICIPALITY OF ____________ )

AFFIDAVIT OF CONSENT AND SUPPORT

I, ______________, of legal age, Filipino, married to _______________, and a resident of

_________________________________________________, after being duly sworn to in
accordance with law do hereby depose and say, THAT:

1) I am the father / mother of the following child(ren):

a)______________________ born on _________________in __________________;

2) I am giving my consent for my child to travel to _______________________ and

accompanied by their __________, _________________________;

3) That his father will be sponsoring their trip and that he is financially capable to support their
stay abroad;

4) That I guarantee that they will not violate any existing laws of __________________;

6) That I execute this affidavit for whatever legal purpose it may serve in connection with my
children’s application for a passport at the Department of Foreign Affairs and/or travel
clearance from the Department of Social Welfare and Development.

IN WITNESS HEREOF, I hereunto sign my name below this ________ DAY OF ________ in
_______________________________.

___________________________
Affiant
(Mother)

SUBSCRIBED AND SWORN TO before me this ______day of ___________ in ______________.

Doc. No. ____________

Page No. ____________
Book No. ____________
Series of ____________
O.R. No. ____________