National Authority for Child Care (NACC) Doc.

NACC–RAU–F-
Code 2022–005
UNDERTAKING AND OATH
REGARDING COMPLETE AND
ACCURATE INFORMATION ON Revision 0
PROSPECTIVE ADOPTIVE PARENT/S No.
AND ADOPTIVE CHILD/REN

I/We, ___________________________________, is/are applying to adopt the

child/ren, __________________________________ who was/were born on
_______________________ in the Philippines and is related/not related to us
by fourth (4th) degree of consanguinity.

Whereas, I/We understand that relative/non-relative adoptions of this type fall

under the rule of Inter-Country Adoption Law of the Philippines;

Whereas, I/We understand that relative/non-relative adoption cases require

special rules due to blood relation/circumstances of surrounding case of the
Prospective Adoptive Parents (PAPs) and the adoptee/s;

Whereas, I/We understand that it is necessary to ensure that complete and

accurate information is given regarding the PAP/s and the child/ren;

I/We therefore acknowledge each of the following to be true and accurate

statements, as verified by my/our initials and sworn signature:

1. All information I/We have provided about myself/ourselves, the adoptive

child/ren and the other family members of the adoptive child/ren (such
as birth certificates, marriage certificates, family trees, death certificates,
divorce decrees, verifications of addresses, employment or income, etc.)
are complete and accurate.
__________ (Initial) __________ (Initial)

2. If there are multiple documents with different information about the

adoptive child/ren or his/her birth parents (such as birth certificates or
marriage licenses, etc.) I/We have provided true copies of each.
__________ (Initial) __________ (Initial)

3. I/We have not made any other or previous pending effort(s) to bring the
above named prospective adoptive child/ren to the ____________
(country) (e.g through medical, tourist, student or relative visa).
__________ (Initial) __________ (Initial)

4. I/We have not made any effort to adopt the child/ren within the Philippine
court system.

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 National Authority for Child Care (NACC) Doc. NACC–RAU–F-
Code 2022–005
UNDERTAKING AND OATH
REGARDING COMPLETE AND
ACCURATE INFORMATION ON Revision 0
PROSPECTIVE ADOPTIVE PARENT/S No.
AND ADOPTIVE CHILD/REN

__________ (Initial) __________ (Initial)

5. If I/We have in fact made an effort to adopt the child/ren within the
Philippine court system, I/We have filed a Motion to Withdraw that
petition and have provided a copy of that Motion, as well as all other
paperwork regarding that adoption petition, to my/our authorized foreign
adoption agency and/or Central Authority.

__________ (Initial) __________ (Initial)

_____________________________ _______________________________
Name and Signature of the Male PAP Name and Signature of the Female PAP
Date: Date:

▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪▪
Acknowledged before me this _____ day of ____________, 20___ in the
State/Province of ________________ Country of _______________.

Notary Public Name __________________ Notary Public Signature

____________________
Notary Public Country of Residence ______________________
My Commission Expires _________________

My Public Seal

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