AFFIDAVIT OF SUPPORT

REPUBLIC OF THE PHILIPPINES

Province of Northern Samar

I, Mitzi Rose T. Llarenas, Filipino, of legal age, single, and a resident of No.156 Jacinto Street
Catarman Northern Samar, after having been duly sworn in accordance with law, hereby depose
and say:
1. That I am the person being supported herein by my parents to accompany them in their travel
overseas;
2. That I am accompanied by my mother, Amparo T. Llarenas and by my father, Julito O.
Llarenas, Proprietor and Businessman respectively;
3. That my parents will guarantee any expenses that would incur during the mentioned overseas
travel.
This affidavit is being executed to the foregoing and in connection with our request to the
Department of Justice for issuance of Special Non-Immigrant
(47a2) Visa of the above-mentioned individuals here in the Philippines.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 20
th
day of March 2013 at
Catarman, Province of Northern Samar, Philippines.

_________________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________
this ____ day of ____________ 20___. The affiant, whom I identified through the following
competent evidence of identity:_______________, valid from to issued by
____________________, personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

Notary Public
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2013.