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AFFIDAVIT OF SUPPORT AND PARENTAL CONSENT

WITH SPECIAL POWER OF ATTORNEY


FOREIGN SERVICE OF THE PHILIPPINES
)
CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES ) SS.
_______________________________________________________ )
I, ________________(name of affiant)____________, Filipino, of legal age, [single]/[married to
_________(name of spouse)_________], and a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance with law, hereby depose
and state:
1. That I am the [father]/[mother] of the minor(s):
LIST OF MINORS:
Name
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

Date of Birth and Age


________________________
________________________
________________________
________________________
________________________

2. That the minor(s) [is]/[are] applying for Philippine passport(s) at the Department of
Foreign Affairs, in order to join me here in ___________(foreign country)____________;
3. That I am willing and able to support him/her/them while being here;
4.
That
[Mr]/[Mrs]/[Miss]_______________________________________________,
presently residing at , ___________________________________ will apply for my
child/childrens passport in the Philippines;
5. That [Mr]/[Mrs]/[Miss] _________________________________________ will
accompany my child/children during their travel from the Philippines to the
______________(foreign country)______________;
6. That I authorize [Mr]/[Mrs]/[Miss] _________________________________________,
presently residing at _________________________________________ to secure a
clearance from the Department of Social Welfare and Development for my
unaccompanied
minor
[child]/[children],
who
will
be
traveling
to
______________________ on _______________________________;
7.
That
my
[child]/[children]
______________________________;

will

be

staying

with

me

at

8. That though the minor(s) [father]/[mother] is not here present, I am giving consent to
said minor(s)s travel in as much as: (check one that applies)
[__] said [father]/[mother] has earlier voluntarily and freely given [his]/[her]
consent, with no condition imposed whatsover, and requested that said consent
be relayed to me.
[__] I have exclusive legal custody of minor (see attached [divorce decree]/[death
certificate]/[etc.])
[__] _________________________________________________________

9. That I assume responsibility for the issuance of the passport and for allowing the trip of
said minor(s) and further assume any and all obligations consequent thereto; and
10. That I am are executing this Affidavit to attest to the truth of the above statement in
connection with said minors application for a Philippine passport.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____th day of ____________
20___ at ____________, Philippines.

_______________(signature)_______________
(Printed Name)

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


_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent Evidence of
Identity)______ issued by the _________(Government Agency)______ on ___(date)__
at ________(place)_________, bearing his photograph and signature, known to me as the
same person who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

Doc. No. ____


Page No. ____
Book No. ____
Series of 20__

Atty ___________________________________________
Notary Public
Commission Serial No. ____________________________
Notary Public for _______(Province/City)______________
Until December 31, 20__
Office: ______________(address)____________________
Roll No. __________
IBP Lifetime Roll No. _________; __/__/__ ; _(Province)_
PTR No. _________ ; __/__/__ ; _(Province)_
MCLE Compliance Cert. No. __________; __/__/__