Affidavit of Intent and Consent to Adoption of Child) 

REPUBLIC OF THE PHILIPPINES)

Province of ____________________)  S.S.
City/Municipality of _____________)

JOINT AFFIDAVIT OF INTENT AND CONSENT

             We, _____________ and _____________, both Filipinos, of legal age,

married and presently residing at _____________, Philippines, having been duly
sworn in accordance with law, hereby depose and state:

           

1.  That we are the legitimate parents of _____________ who was born on

_____________ in _____________, Philippines.

2.  That we have not, at any time abandoned said minor child.

3.  That we are unable to support said child and that believing that it would
be for (his/her) own interest and benefit, we, hereby signify our written
intent, freely and voluntarily to have our (son/daughter) _____________ be
adopted.

4.  That we also signify our written consent, freely, willingly and voluntarily
to have our (son/daughter) _____________ be legally adopted by the
spouses _____________ and _____________ of _____________,
Philippines in accordance with law.

5.  That we are ready and willing, freely and voluntarily to abdicate our
parental authority over said child in favor of the spouses _____________
and _____________, who are _____ and _____ years of age, respectively,
and who are both possessed of the necessary civil and legal rights as well
as the financial capacity to raise, rear and support said child, after the
adoption proceeding had been instituted and an order of adoption be
issued.

6.  That we execute this affidavit to declare our intention and consent to the
adoption of our (son/daughter) _____________ as well as to the truth of the
foregoing facts.

 
 IN WITNESS WHEREOF, we have hereunto set our hands this
_____________ at _____________, Philippines.

 __________________________ ________________________
AFFIANT                                                             AFFIANT

 SUBSCRIBED AND SWORN to before me, this _____________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
issued on _____________ at _____________, Philippines.

NOTARY PUBLIC

Doc. No. ______;

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