A F F I D A V I T OF CONSENT

(Parental Travel Permit)

I, [details], after having been duly sworn to in accordance with law do hereby
depose and state:

1. That I am are the biological mother and person exercising parental authority
over minor XXX, who is 17 years old;
2. That his father, xxx is working in xxx, USA, as such I am his parent exercising
parental authority over him;
3. That the child will travel to the United States of America for the following
reason/s: xxx;
4. That the mentioned child will be leaving on or before xxx and will stay with his
father who will take care of him;
5. That I cannot personally travel with my child due to xxx;
6. That I am giving my full consent for the minor child to travel abroad
accompanied by his father xxx;
7. That I personally guarantee that he will not in any manner become public
ward of any authority of any country he may happen to pass en route to his
destination;
8. That this affidavit was executed for the purpose of attesting to the truth of the
foregoing facts and for whatever legal purpose it may serve; and
9. Affiant further sayeth naught.

IN WITNESS HEREOF, I have hereunto set my hand this xxx at xxx.

NAME
Affiant

Republic of the Philippines )

MACABEBE, PAMPANGA ) S.S.

SUBSCRIBED AND SWORN to before me this xxx.