REPUBLIC OF THE PHILIPPINES )

LEGAZPI CITY, ALBAY ) S.S.

AFFIDAVIT OF SUPPORT AND GUARANTEE

I, _________________, of legal age, Filipino, married, and a resident of

_________________, after being sworn to in accordance with law, hereby depose and state
that:

1. I am the grandfather of _____________, who was born on _________________;

2. My grandson will travel to _________________, on _________________ and will stay until

_________________ together with his parents, _________________;

3. That I personally guarantee the financial support of my grandson and his nanny in
the course of their travel and stay outside the Philippines and further guarantee
that they will not in any manner become a burden to the Philippine and other
governments;

4. I am executing this Affidavit in connection with my grandson’s application for a US

Visa, to attest to the truth of the foregoing statements and for whatever legal
purpose/s it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

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

______________.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this ___________ at ______________, affiant

exhibited to me his _______________, as competent evidence of his identity.