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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)
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. __________; __/__/__