SPECIAL POWER OF ATTORNEY

WITH
AFFIDAVIT OF SUPPORT AND CONSENT
(For passport and DSWD travel clearance applications of minor/s)

I / WE, _______________________ and ___________________, both Filipino,

and of legal age, with permanent address at ________________________ Philippines,
and presently residing in Doha, State of Qatar, after having duly sworn to in accordance
with law, hereby depose and say:

1. That I am / we are the biological parent/s exercising parental authority over

minor/s, namely:

Full name Date of Birth Place of Birth

2. That I / We have appointed ________________________ (name of companion

at DFA and DSWD) to apply for, claim, and receive the passport, and DSWD
Travel Permit of said minor/s;

3. That said minor/s will travel to ___________________ (country of destination)

this year with ______________________________ (name of travel companion);

4. That I am / We are giving our full support and consent to the travel of
abovementioned minor/s and assume any and all obligations consequent
thereto; and

5. That I am / We are executing this Special Power of Attorney with Affidavit of

Support and Consent to attest to the truth of the above statements.

IN WITNESS WHEREOF, I / We have hereunto set my hand this _______________

at the Philippine Embassy, Doha, State of Qatar.

_________________________________ _________________________________
Signature over Printed name of FATHER Signature over Printed name of MOTHER
Passport No. : __________________ Passport No. : __________________
Date Issued : __________________ Date Issued : __________________
Place Issued : __________________ Place Issued : __________________

WITNESSES:

_____________________________ __________________________________

Philippine Embassy Doha, State of Qatar - Sample Form for Special Power of Attorney with Affidavit of Support and Consent (for
passport and DSWD Travel clearance of minor/s)
Requirements: 1) Personal appearance of both parents (if both in Qatar); 2) One copy each of valid Philippine epassport; 3) QR100
(cash payment only)