REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF _____________ ) S.S.

x-------------------------------------x

AFFIDAVIT OF CONSENT
That I, _______________________, of legal age, single, Filipino and a resident
of _________________ after having been duly sworn to in accordance with law
hereby depose and state;

1. That I am the biological mother of _____________________________, who

was born on __________________;

2. That my child is intending to travel with companion of

_________________________ to _____________ for a vacation/tour for a
period of ___________days;

3. That I do not oppose to this travel and hereby gives my full consent to
my child for him to have an opportunity to see other places;

4. That I personally guarantee the financial support of my child in the

course of his travel and stay outside the Philippines;

5. That I have executed this affidavit to attest to the truth of all the
foregoing statements and for all legal intent and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ day

of ________ at ____________________.

_________________
Affiant

SUBCRIBED AND SWORN TO before me this __________day of

________________ in Paniui, Tarlac Philippines

Doc. No. ;
Page No. ;
Book No. ;
Series of _____.