Republic of the Philippines)

Province of Surigao del Sur)

Municipality of Tago)s.s.

AFFIDAVIT

I, DR.X, twenty-seven (27) years of age, Filipino, and resident

of___________, after having been sworn to in accordance with law, do hereby
depose and say THAT:

1. I am the same person executing this Affidavit;

2. I am the son of Spouses ___________and _____________;

3. I am aware that my parents are intending to adopt John Doe;

4. I signify my written consent, freely, willingly and voluntarily for the

adoption of John Doe, in accordance with law, with my parents
________as the adopters;

5. I am ready and willing, freely and voluntarily to accept John Doe as

my brother, to have the same rights and privileges with me as a
legitimate child of my parents; and

6. I am executing this affidavit to attest to the veracity of the foregoing

without being forced or coerced.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________, 2020 in Tago, Surigao del Sur, Philippines.

DR. X
Affiant
ID No.:

SUBSCRIBED AND SWORN to before me this __________, 2020 at

Tago, Surigao del Sur, after affiant showed to me his competent evidence of
identity as mentioned above and being satisfied that he understood and
voluntarily executed this affidavit.

Doc No.____
Page No. ___
Book No.___
Series of 2020