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I

I,
Filipino, legal age,
at
do hereby appoint and constiiute
, of legal age
Print name of representative
current resident of
, Philippines
Address of rc pre se ntative-
having been sworn to in accordance with raw,'rrereov
Jepose and sav:
1. That I am the of the following mino(s):
Relationsh ip to minorls)
Name Age Date of Birth Place of Birth

2. That I have authorized


Print name of representative

, to iapply for and secure passporls, visas and


Relationsh ip to principat
other documents to faciritate the traver of the above minor(s)
to
3. That I have given full authoritv to
, to make
pint name of representatiie
appropriate travel arrangem€)nts f,cr the above-n"r"J mino(s);

4. Please check one of the following below:

That I authorize
to
Print name of representative
accompany said minor(s) during travel to

That I will personally travel ilo the philippines to accompany the


above-named minor(s) during travel to

That I give my consent for the above-named minor(s), who are 13


years old or older, to travel alone and be assisted by'airline personnel
during travelto
5. That I am gainfully employed as by-
Position Name of Company or Employer
& hereby undertake to support tfre above-named minor(s) diring trrJli'siay
That this affidavit is being executerd to attest to the truth of the foregoing
and
suppotl the application for passports and other travel documents tor tnJ aOor
named minor(s).

lN wlrNESS wHEREoF, I have rhereunto affixed our/my hand this day


_20-in the city of Seoul, South Korea

Affiant