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I, FLORDELIZZA RAZON ABELLERA, of legal age, Filipino, married and presently residing at Tuy,
Batangas after having been duly sworn to in accordance with law, depose and state:

1. That I am the biological mother of Nicole D’lonreign Abellera Comia who was born on
November 07, 2003 in Batangas City;

2. That said child will to travel to Japan for tourism;

3. That I am giving my full consent for the minor child to travel abroad to be accompanied by
4. That I personally guarantee the financial support of the child in the course of her travel and
stay outside the Philippines and further guarantee that she will not in any manner become a
burden to the Philippine and Japan governments.

5. That I am executing this affidavit in connection with my child application for a passport at the
Department of Foreign Affairs and/or travel clearance from the Department of Social Welfare
and Development for her travel abroad.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ of October 2015 in BALAYAN,
BATANGAS, Philippines.

Flordelizza R Abellera
Philippine Passport No. EC4982607
Issued at: DFA Manila
Issued on: August 15, 2015

SUBCRIBED AND SWORN TO before me this ___________________ in BALAYAN, BATANGAS,

Philippines, affiant exhibiting to me her valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.