REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ____________________ )SS

MUNICIPALITY/CITY OF ____________)

IN RE: PETITION FOR DOMESTIC

ADMINISTRATIVE ADOPTION OF Domestic Administrative
MINOR (CHILD’S NAME) Adoption Case No:

______________________

(NAME OF PROSPECTIVE ADOPTIVE

PARENT/S)
Prospective Adoptive Parent/s,

x-----------------------------------------------------------x

PETITION FOR ADOPTION

That I/we, (Name of PAP/s), (Nationality), of legal age, (single/married) on (date

and place of marriage, if applicable) and resident/s of (complete home address), after
having been duly sworn in accordance with the law, hereby depose and say:

1. That I, (name of male PAP), was born on (date of birth) at (place of birth). My
mother is (name of mother), a (citizenship of mother) citizen at the time she gave birth
to me, and my father is (name of father), a (citizenship of father) citizen at the time of
my birth. Copy of my Certificate of Live Birth issued by the (name of issuing office) is
hereto attached as Annex "A".

(Include this statement if male PAP is a foreign national)

Having been born in the (country of birth), I am likewise a citizen thereof and
thus, a holder of a (country passport), copy of which is hereto attached as Annex "A-1”.
I was issued with a Philippine visa by the Philippines Bureau of Immigration, hereto
attached as Annex “A-2”.

2. That I, (name of female PAP), was born on (date of birth) at (place of birth). My
mother is (name of mother), a (citizenship of mother) citizen at the time she gave birth
to me, and my father is (name of father), a (citizenship of father) citizen at the time of
my birth. Copy of my Certificate of Live Birth issued by the (name of issuing office) is
hereto attached as Annex "B".

(Include this statement if female PAP is a foreign national)

Having been born in the (country of birth), I am likewise a citizen thereof and
thus, a holder of a (country passport), copy of which is hereto attached as Annex "B-1”.
I was issued with a Philippine visa by the Philippines Bureau of Immigration, hereto
attached as Annex “B-2”.

3. That the child we sought to adopt is (name of the child) born on (date of birth)
at (place of birth). The birth parent/s of the child is/are (name of birthparent/s or
unknown). Copy of child’s Certificate of Live Birth issued by the Philippine Statistics
Office is hereto attached as Annex "C".

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(Include this statement if the case was presented during the matching conference)
4. A (regional/interregional) matching conference was conducted by the
(RACCO/NACC) on (date of matching conference). The (Regional/Child Placement
Committee) has recommended the adoption placement of (name of child) with us.
Certificate of Matching is hereto attached as Annex “D”. The (RACCO/NACC) issued
the Pre-Adoption Placement Authority on (date of PAPA issuance) signed by (name of
signatory), hereto attached as Annex “D-1”.

5. That adoption social worker, (name of social worker), conducted the necessary
supervised trial custody (STC) and submitted reports to the Regional Alternative Child
Care Office (RACCO).

6. That adoption social worker, (name of social worker), prepared the Social
Case Study Report (SCSR) dated (date of SCSR) and approved by (name and position
of signatory, if applicable) of (name of agency). The SCSR is hereto attached as Annex
“E”.

7. That, as may be applicable, the following person/s have given the consent to
the adoption: (please check)

_____ The child, if ten (10) years of age or older;

The biological parents of the child, if known, or the legal guardian,

or the proper government instrumentality which has legal custody
of the child, except in the case of a Filipino of legal age if, prior to
the adoption, said person has been consistently considered and
treated as their own child by the adopters for at least three (3)
years;
_____

The legitimate and adopted children, ten (10) years of age or over,
_____ of the adopters, if any;

The illegitimate children, ten (10) years of age or over, of the

adopter if living with said adopter or even whom the adopted
_____ exercises parental authority and the latter’s spouse, if any; and
_____ The spouse, if any of the persons adopting or to be adopted.

8. That I/we, am/are financially, physically, and morally capable, hence in the
best position to rear and provide for the needs of the child as evidenced by the attached
documents.

9. That I/we possess all the personal qualifications required under the Republic
Act No. 11642 and I/we am/are qualified to adopt.

10. That the following documentary requirements form part of this Petition, hereto
attached as;

Annex F-1 Updated Social Case Study Report;

Annex F-2 Authenticated or Security Paper copy of Marriage Certificate
or Authenticated or Security Paper copy of Certificate of No
Marriage;
Annex F-3 Birth Certificate of the PAPs
Annex F-4 Birth Certificate of the Child

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 Annex F-5 National Bureau of Investigation or Police Clearance or
Court Clearance
Annex F-6 Medical Evaluation of the PAPs;
Annex F-7 Medical Evaluation of the child;
Annex F-8 Psychological evaluation of the PAPs;
Annex F-9 Written consent/s to the adoption by those stated in #9
Annex F-10 Documents showing financial capacity;

Annex F-11 Child Care plan with a list of three (3) temporary custodians
of the child in order of preference in case of death, absence,
or incapacity of the PAPs;
Annex F-12 Letters attesting to the character and general reputation of
the PAP/s from at least three (3) non-related character
references of one preferably from an employer or supervisor
or with whom the PAP/s have business dealings;
Annex F-13 Recent 5R (127 x 178 millimeter) close-up and whole-body
pictures of the child;
Annex F-14 Recent 5R (127 x 178 millimeter) close-up and whole-body
pictures of the PAP/s.

Annex F-15 Certificate of Attendance/Undertaking regarding attendance

to Pre-Adoption Training
If applicable,
Annex F-13 Original Copy of the Certificate Declaring a Child Legally
Available for Adoption (CDCLAA);
Annex F-14 Psychological evaluation of the child, for children five (5)
years old and above prepared within two (2) years based on
the date of the report;
Annex F-15 Authenticated or security paper copies of the Death
Certificate of the child’s biological parents;
Annex F-16 Authenticated Divorce papers with copy of court decision
and Certificate of Finality by their Consulate if foreign
applicant;
Annex F-17 Annulment Decree with Certificate of Finality, Declaration of
Nullity or Legal Separation Documents for Filipino applicant;
Annex F-18 If foreign national, clearance from police authorities where
he/she has lived for more than twelve (12) months anytime in
the past fifteen (15) years.

11. That I/we, am/are shall appear before the (RCPC/NACC) to prove and
strengthen my/our fitness and qualification to adopt on the date to be determined by the
latter.

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 That the grant of this Petition shall create a legal status to our existing parent-
child relationship and shall redound to the best interest of the child, as he/she may then
enjoy the benefits of a legally adopted child as sanctioned by the laws.

PRAYER

WHEREFORE, premises considered, it is respectfully prayed for the Executive

Director of the National Authority for Child Care, upon notice and publication, that an
Order of Adoption be issued declaring (name of child) for all legal intents and purposes,
my/our legitimate child, and hereby directing that (name of child) shall be known as
(new name of child).

Other reliefs just and equitable under the circumstances are also prayed for.

Further Affiant/s sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (date of

signing), at (place of execution).

_____________________________
Name and Signature of PAP/s

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

____________________ this ______ day of _______________ 20____ by the
following, who exhibited to me their respective government issued ID, as follows:

Name Government-issued ID Date and Place Issued

1.

2.

This instrument consists of ____ pages including this page where the notarial
seal is affixed.

Doc. No. ______;

Page No. ______; NOTARY PUBLIC
Book No. ______;
Series of ______.

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