REPUBLIC OF THE PHILIPPINES

PROVINCE OF DAVAO DEL NORTE

MUNICIPALITY OF PANABO CITY

AFFIDAVIT OF CONSENT AND SUPPORT

I, ______________________, of legal age, Filipino, married to ___________________,

and a resident of___________________________________________, after being duly sworn
to in accordance with law do hereby depose and say, THAT:

1) I am the mother of __________________, who was born on _______________________

in __________________________________________________;

2) I am giving my consent for my child to travel to ___________________ and accompanied

by their uncle __________________________;

3) That I am sponsoring their trip and that I am financially capable to support their stay
abroad;

4) That I guarantee that he will not violate any existing laws of ______________________;

6) That I execute this affidavit for whatever legal purpose it may serve in connection with
my child’s application for a passport at the Department of Foreign Affairs and/or travel
clearance from the Department of Social Welfare and Development.

IN WITNESS HEREOF, I hereunto sign my name below this _______________________ in

____________________________________.

___________________________
Affiant
(Mother)

SUBSCRIBED AND SWORN TO before me this ______day of ___________ in ______________.

Doc. No. ____________

Page No. ____________
Book No. ____________
Series of ____________
O.R. No. ____________