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(Intent and Consent to Adoption of Child)

Republic of the Philippines)

_____________)-----------------S.S.
x-- - - - - - - - - - - - - - - - - ---- - x

JOINT AFFIDAVIT OF INTENT AND CONSENT

I, ___________, Filipino, of legal age, presently residing at

_______________________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

1.That I am the legitimate mother of _________________ who was born on

_______________ in San Roque, Zamboanga City, Philippines.

2.That I have not, at any time, abandoned said minor child;

3.However, I am unable to support said child and that believing that it would
be for his own interest and benefit, I, hereby signify my written intent, freely
and voluntarily to have my son _______________ be adopted.

4. In turn, we likewise _____________ and _______________ signify our

written consent, freely, willingly and voluntarily to legally adopt
________________ in accordance with our laws on adoption.

5.That I am ready, willingly, to freely and voluntarily, abdicate my 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 _________________ as well as to the truth of the
foregoing facts.

IN WITNESS WHEREOF, we have hereunto set our hands this

__________________ at _____________, Philippines.

____________________ ____________________
(Signature Over Printed ) (Signature Over Printed)
Affiant Affiant

__________________
(Signature Over Printed)
Affiant
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ACKNOWLEDGMENT

Republic of the Philippines )

______________-------------- ) S.S.
x-------------------------------------x)

BEFORE ME, this ________________ at ___________________, personally

appeared ___________________, ___________________and
___________________known to me and to me known to be the same persons
who executed the foregoing instrument and they acknowledged before me
that the same is their free and voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal on the
date and place first above-stated.