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I/We,____________________________________ / ___________________________________ of legal age(s),

(name of applicant/s)
single/married/widower/separated and resident of _______________________________________________________,
(address in the UK)
hereby declare under oath, that:

1) I/We am/are immigrant/s/citizen/s contract worker/s of/in the United Kingdom;

2) I/We am/are employed by ________________________________________________________________________
with a monthly salary of ______________________; (name and address of employer)

3) That my/our child/children ____________________________________ / __________________________________

will be travelling to join me/us in the United Kingdom; (name(s) and age(s) of child/children)

4) That I/We am/are willing and able to support him/her/them while in the United Kingdom;

5) That my/our child/children will live and stay with me/us at the above address;

6) That I/We do hereby name, appoint and constitute Mr/Mrs/Ms __________________________________________

presently residing at ______________________________________________________ to be my/our true and lawful
Attorney, for me/us and in my/our name(s), place(s) and stead(s), to secure a clearance from the Department of Social
Welfare and Development (DSWD) and to apply for Philippine passport from the Department of Foreign Affairs (DFA)
for my/our minor child/children, who will be travelling to join me/us in the United Kingdom on ____________________;
(tentative date of travel)

7) That I/We am/are giving my/our full consent to the travel of the aforementioned child/children abroad to be
accompanied by ______________________________________________ / ________________________________;
(name of person accompanying and relationship to the child/children)

8) That this affidavit was executed for the purpose of attesting to the truth of the facts above stated and for whatever
legal purpose it may serve:

Affiant further sayeth naught.

IN WITNESS WHEREOF, I/We have hereunto signed this Affidavit this ______ day of _________________ 20___ at
London, United Kingdom.

______________________________ ______________________________
(father’s signature) (mother’s signature)
Philippine/UK Passport No. __________ Philippine/UK Passport No. __________
Date of Issue _______________ Date of Issue _______________
Place of Issue _______________ Place of Issue _______________

WITNESSES: ______________________________ _____________________________

ascspa form revised 10/08 – Philippine Embassy, London This form is not for sale and can
be reproduced