Republic of the Philippines)

Calamba, Laguna ) S.S.

AFFIDAVIT OF CONSENT TO TRAVEL

I, _____________________, Filipino, __ years of age and resident of

_____________________________, Calamba, Laguna, after having been duly sworn in
accordance with law, do hereby depose and say:

1. That I am the biological mother of Khristel B. Dimaculangan, born on 19 June 2007,

and hereinafter referred to as “Khristel”;

2. That Khristel is in the custody of her biological father, Michael S. Dimaculangan,

since 2015;

3. That her father would like to travel with Khristel to Hongkong for a 3-day vacation
from ______ to ______________;

4. That her father will shoulder all the expenses for the said trip;

5. That I hereby give my consent for my daughter, Khristel, to travel with her father on
the dates mentioned above;

6. That I am executing this affidavit to attest to the truth of the foregoing statements
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

______________ in Calamba, Laguna, Philippines.

__________________
Affiant
          

SUBSCRIBED AND SWORN to before me this ______________________ in

Calamba, Laguna, the affiant having been exhibited to me her
_________________________________________________, personally signed the foregoing
instrument before me and acknowledged to me that he freely and voluntarily executed the
same.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2019.