Republic of the Philippines

Inter - COUNTRY ADOPTION BOARD

No. 2 Chicago cor Ermin Garcia Streets
Barangay Pinagkaisahan, Cubao, Quezon City

IN THE MATTER OF THE ADOPTION OF THE MINOR

AAAA

YYYY, Petitioner.
x--------------------x/

PETITION FOR INTER - COUNTRY ADOPTION

PETITIONER, through the undersigned counsel and to this

Honorable Court, most respectfully states, THAT:

1. Petitioner YYYY, is a American, of legal age, married,

and residing and with postal address at Block 1, ZZZZ Street,
Los Angeles, California, hereby apply for the adoption of a
Filipino child/children.

2. He desires to adopt a Filipino minor child named AAAA

born on February 26, 2014 in Cabanatuan City, Nueva Ecija.
He is five year and nine months old as of this date of the
Petition and a resident of Cabanatuan City, Nueva Ecija.

3. AAAA is born out of wedlock and illegitimate child of

XXXX.

4. Petitioner is a citizen of the United States of America

where the Philippines has a diplomatic relations have the
legal capacity to adopt in his country, and his government
allows the adoptee to enter his country as his adopted child.
A copy of the Certification of the Embassy of the United
States is attached hereto as Annex B.

5. The petitioner was married to XXXX on May 1, 2017 and

has continuously lived in the Philippines since the time of
the marriage up to the time of the Filipino of this petition.

6. Petitioner is in possession of full civil capacity and

legal rights; of good moral character; has not been
convicted of any crime involving moral turpitude;
physically, financially, emotionally and psychologically
capable of caring for AAAA; at least sixteen (16) years
older than AAAA; capable to maintain, care for, educate,
and support AAAA in keeping with the means of the family;
and physically healthy. Petitioner XXXX earns his income
by working as a hospital physician.

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 7. That he agrees to uphold the basic rights of the
child, as embodied under Philippine laws and the U.N.
Convention on the Rights of the Child, and to abide by
the rules and regulations issued to implement the
provisions of Republic Act No. 8043

8. Thus, Petitioner have all the qualifications and none

of the disqualifications under the law to adopt AAAA, who
is not disqualified by law to be adopted. It will be for
the best interest of the minor child to be adopted by his
step-father.

9. In conjunction with this petition, Petitioners seeks

that a Certificate of Live Birth with the following details
be issued, to wit:

Name of Child: AAAA

Sex: Male
Date of Birth: February 26, 2014
Name of Mother: XXXX
Citizenship : Filipino
Religion: Roman Catholic
Occupation: Nurse
Age at the time of this birth: 35
Name of Father CCCC
Citizenship: Filipino
Religion: Roman Catholic
Occupation: Self-employed

PRAYER

WHEREFORE, premises considered, it is most respectfully

prayed of this Honorable Court, after due notice,
publication, and hearing to issue a decree of adoption
declaring that the minor child AAAA be considered as the
legitimate child of Petitioners, and that the Local Civil
Registrar be directed to issue a Birth Certificate with the
following details:

Name of Child: AAAA

Sex: Male
Date of Birth: February 26, 2014
Name of Mother: XXXX
Citizenship : Filipino
Religion: Roman Catholic
Occupation: Nurse
Age at the time of this birth: 35
Name of Father YYYY
Citizenship: American
Religion: Roman Catholic
Occupation: Hospital Physician

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 Other relief and remedies, just and equitable, are
likewise prayed for.

YYYY
_______________
PETITIONER

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 VERIFICATION AND CERTIFICATION
OF NON – FORUM SHOPPING

That, I XXXX, of legal age, Filipino Citizen and a resident of Cabanatuan City,
Nueva Ecija, after having been duly sworn to in accordance with law, do hereby
depose and states:

That, I am the petitioner of the above-entitled case and have caused the
preparation of the foregoing position paper and hereby certify that all the allegations
contained therein are true and correct of my own knowledge and belief;

That, I have not commenced any action or proceeding involving the same issues
in the Supreme Court, Court of Appeal or different division thereof or any other
Court, Tribunal or Agency.

That to the best of my knowledge, no such action or proceeding is pending

before the Court of Appeal, Supreme Court or any other tribunal agency;

That If I should thereafter learn that a similar action or proceeding has been
filed or is pending before the Court of Appeal, Supreme Court or any other tribunal
or agency I undertakes to promptly inform the aforesaid courts and other tribunal or
agency thereof within five (5) days therefrom.

That this certification is in compliance with the requirements prescribed in the

Revised Circular No. 23-94 dated February 8, 1994 effective April 1, 1994 issued
by the Supreme Court.

In Witness Whereof, I have hereunto set my signature this 28th day of November
2019, hereat Cabanatuan City.

_______________________ ______________________
XXXX YYYY
Affiant Affiant

SUBSCRIBED AND SWORN to before me this 28th day of November 2019

hereat Cabanatuan City, affiant exhibited to me her Competent Evidence of Identity
No. indicated below her name and signature.

Doc. No.
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Book No.
Series of 2019