REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LEYTE ) S. S.
MUNICIPALITY OF HINDANG )

AFFIDAVIT OF CONSENT AND SUPPORT

I, GEMMA HACHASO, of legal age, Filipino, married and a resident of Bonifacio St.
Pob. II Hindang, Leyte, after being duly sworn to in accordance with law do hereby depose
and say, THAT:

1) I am the guardian of MEJAILLA SHEEN R. PAYOT. Who was born on JANUARY 7,

2000 in BRGY. POB. II HINDANG LEYTE;

2) I am giving my consent for my child to apply for VOUCHER PROGRAM

3) That I am sponsoring their trip and that I am financially capable to support their stay
abroad;

4) That I guarantee that he will not violate any existing laws of SOUTH KOREA;

6) That I execute this affidavit for whatever legal purpose it may serve in connection with
my child’s application for a passport at the Department of Foreign Affairs and/or travel
clearance from the Department of Social Welfare and Development.

IN WITNESS HEREOF, I hereunto sign my name below this 17TH DAY OF MARCH 2018 in
IMBENTO CITY, BATANGAS.

___________________________
Affiant
(Mother)

SUBSCRIBED AND SWORN TO before me this ______day of ___________ in ______________.

Doc. No. ____________

Page No. ____________
Book No. ____________
Series of ____________
O.R. No. ____________