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

(JURAT)