Republic of the Philippines)

Quezon City ) s.s.

AFFIDAVIT OF SUPPORT

I, JOSEPHINE DELA CRUZ, of legal age, widow, Filipino and with postal office address
at ________________________________, after having been duly sworn in accordance
with law, hereby depose and state that:

1. I am the legal guardian of the minor, Samantha Mendoza who was born on April
6, 2000 in San Juan City. Attached is certified true copy of the court’s decision
appointing me as the legal guardian.

2. I will be shouldering all her travel expenses for our short travel to Korea from
_____________ to ______________.

3. I have enough funds to support her for this trip.

4. I am executing this Affidavit for all legal intents and purposes to request the
proper authorities to issue the corresponding travel documents.

FURTHER AFFIDAVIT SAYETH NAUGHT

JOSEPHINE DELA CRUZ

Affiant

SUBSCIBED AND SWORN TO before me this ______day of________2015 at Quezon

City Philippines. Affiant exhibited to me her DFA passport number ________________
issued on _________ valid until __________.

Doc. No.:
Page No.:
Book No.:
Series of 2015