Republic of the Philippines)

Province of________________)S.S.
City/Municipality of ____________)
x-- - - - - - - - - - - - - - - - - - - x
JOINT AFFIDAVIT OF INTENT AND CONSENT

We,___________and__________,both Filipinos, of
legal age, married and presently residing
at____________, Philippines, having been duly
sworn in accordance with law, hereby depose and
state:

1.That we are the legitimate parents of

____________who was born
on____________in___________ Philippines.

2.That we have not, at any time abandoned said

minor child.

3.That we are unable to support said child and

that believing that it would be for (his/her)own
interest and benefit, we, hereby signify our
written intent, freely and voluntarily to have
our(son/daughter) ____________be adopted.

4.That we also signify our written consent,

freely, willingly and voluntarily to have our
son/daughter)____________be legally adopted by
the spouses_________and___________of___________,
Philippines in accordance with law.

5.That we are ready and willing, freely and

voluntarily to abdicate our parental authority
over said child in favor of the
spouses____________and_____________, who are
____and _____years of age, respectively, and who
are both possessed of the necessary civil and
legal rights as well as the financial capacity
to raise, rear and support said child, after the
adoption proceeding had been instituted and an
order of adoption be issued.

6.That we execute this affidavit to declare our

intention and consent to the adoption of our
(son/daughter)_________as well as to the truth
of the foregoing facts.

IN WITNESS WHEREOF, we have hereunto set our

hands this____________at"_____________,
Philippines.

Affiant Affiant