REPUBLIC OF THE PHILIPPINES )

CITY OF ANGELES ) S. S.

AFFIDAVIT OF CONSENT

I, ___________________, of legal age, Canadian citizen, and a resident of

______________________________, after being duly sworn to in accordance with law do
hereby depose and say, THAT:

1. I am the biological father of ______________who was born on ____________ in

_____________;

2. I acknowledge that, and I am giving my consent and permission for my child to travel to
the United States of America to be accompanied by his biological mother _________________,
who has parental custody over our child;

3. That I execute this affidavit for whatever legal purpose it may serve in connection with
my child’s travel to the United States of America.

IN WITNESS HEREOF, I hereunto sign my name below on ___________________in

Angeles City, Philippines

___________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ______________________ in Angeles

City, affiant exhibiting to me his ________________________________ valid until
__________________.

Doc. No. ____________

Page No. ____________
Book No. III;
Series of 2020.