REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF BAGUIO ) s.s.

AFFIDAVIT OF SUPPORT AND CONSENT

I, _______________________, of legal age, single, Filipino and residing at

_________________________________, after having been sworn to in accordance
with law, hereby depose and state:

That I am the mother of the minor, ___________________________ who

was born on April 16, 2007 at the _____________________;

That I am planning to bring my son, _______________________ to Hong

Kong next year for a vacation;

That I am gainfully employed thus, I have the financial capability to provide for
all the needs of my son while in Hong Kong;

That I am executing this affidavit to attest to the truth of the foregoing and in
support of my son’s application for the issuance of a Philippine passport in
connection with our intention to travel to Hong Kong for a vacation next year and for
all other legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 2nd

day of _______________, in Baguio City, Philippines.

_________________________
Affiant
TIN No. ______________
Date of Issue: August 18, 2010
Place of Issue: BIR, ____________

SUBSCRIBED AND SWORN TO before me, on this 2nd day of November,

2015, in _______________________, Philippines, affiant exhibited to me her
Driver’s License, the particular of which are indicated hereinabove.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015.