Republic of the Philippines )

Calamba Misamis Occidental )s.s.

AFFIDAVIT

I, X, 26 years old, Filipino citizen, single and a resident of Baluarte Punta

Sulong, Misamis Occidental, after having been sworn in accordance with law,
hereby depose and say:

1. That I am the mother of Y born on A;

2. That I acknowledged having the sole parental right over my illegitimate

child;

3. That Z is the father of the said child;

4. That I am giving temporary custody of Y to Z;

5. That I shall not extinguished my visitation rights with the child;

6. That it is to the best child's overall well-being, including care for his safety
and basic needs, education, and stability that the child shall be put
temporarily in his father’s custody.

That I execute this Affidavit freely and voluntarily to attest to the foregoing
facts and for whatever legal purpose this may serve.

FURTHER, Affiant sayeth none.

IN WITNESS WHEREOF, I hereunto set my hand this 27th day of November

2017 at Calamba Misamis Occidental, Philippines.

X
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of November 2017 at

Calamba Misamis Occidental, Philippines.

CDS
PUBLIC ATTORNEY I
PUBLIC ATTORNEY’S OFFICE
PURSUANT TO RA 9406