REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA ) S.S.

AFFIDAVIT OF CONSENT

I, _____________________________________, of legal age, married, Filipino Citizen,

residing at ______________________________________________, after having duly sworn to
in accordance with law, do hereby depose and state:

1.) That my legitimate son/daughter _________________________________, was

born on ______________________________;

2.) That my son/daughter is intending to apply for a Student Driver’s License before
the Land Transportation Office, Field Office _________________;

3.) That as one of the requirements, among others, in the issuance of the
aforementioned license, I hereby give my parental consent to my son/daughter to be able for
him/her to secure the Student Permit License before the Land Transportation Office;

4.) That I am executing this Affidavit to attest to the truth of the foregoing facts and
respectfully request the Land Transportation Office to issue a Student Permit License in favor of
my son/daughter.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of

___________________ at Guagua, Pampanga.

__________________________________
AFFIANT
I.D. ____________________________________

SUBSCRIBED AND SWORN to before me on this ______ day of

_______________________ at Guagua, Pampanga. Affiant exhibited to me his Identification
Document stated below his name.

Doc No. ______

Page No. _____
Book No. _____
Series of 20_____.