REPUBLIC OF THE PHILIPPINES)

_______________, NORTHERN SAMAR) S.S

AFFIDAVIT OF CONSENT OF THE BIOLOGICAL CHILD OF

OF THE PROSPECTIVE ADOPTER

I, AIRENE MADRONIO NILLO, legal age, Filipino, married and presently

residing at Brgy. __________ Poblacion, ________________, Northern Samar, after
having been duly sworn to in accordance with law, do hereby depose and say
THAT:

1. I am the child of the prospective adopter for Adoption applied by

Spouses FELEMON MADRONIO AND MYRNA TINGZON MADRONIO;

2. I am voluntarily and freely giving my consent of administrative adoption

of DANNISE LOREEN MADRONIO by Spouses FELEMON MADRONIO
AND MYRNA TINGZON MADRONIO the without any condition imposed
whatsoever;

3. I am fully aware of the effects and consequences of adoption of the

DANNISE LOREEN MADRONIO;

4. I am executing this affidavit in relation to the petition of Spouses

FELIMON MADRONIO AND MYRNA TINGZON MADRONIO for
Adoption to attest the truth of the foregoing facts and for whatever legal
purpose it may serve.

AFFIANTS FURTHER SAYETH NOT.

IN WITNESS WHEREOF, I have hereunto set our hands this _____ th day
of _____________2022 at ____________________, Northern Samar.

AIRENE MADRONIO NILLO

Affiant
Proof of Identity: __________________________________

BEFORE ME, appeared the above-mentioned persons, presenting the

above AFFIDAVIT OF CONSENT OF CHILD OF PROSPECTIVE ADOPTER, who
are personally known to me or identified by me through competent evidence of
identity as defined by the Notarial Rules as the persons who sign the document
and, in my presence, taken an oath or affirmation before me as to such
document.

SUBSCRIBED AND SWORN to before me on _____________at

____________Northern Samar.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2022

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