AFFIDAVIT OF UNDERTAKING

I/We, _____________________________________________, of legal age, ____ residence and

with a postal address at ____________________________________________, after having
been duly sworn to in accordance with the law hereby depose and state that:

1. I am the companion of minor ______________________________________ who

together with me will travel to ___________________ on ____________ for the
purpose of _______________________________________.

2. That the said minor is the _________________ of _____________________________

who gave their full consent and permission to me as companion of their minor
daughter/son;

3. I am a ___________________________ of _________________________________

4. I hereby undertake and affirm that, I, together with the minor/child will return to the
Philippines as soon as we finish the duration of our __________________ in
____________________ and promise to inform the Minors Traveling Abroad Section,
DSWD X Office 5 days upon arrival:

5. I assume full responsibility over the minor’s safety and welfare during the entire
duration of our travel and stay at ___________________________________________
and hold the staff, officers and or any employee of DSWD X free and harmless from
all and any liability arising from the travel of the said minor;

6. I executed this affidavit to attest to the truth of the foregoing facts and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of

__________, 2023 at______________________________

________________________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this _________day of _____________, 2022 at

_____________________________ affiant exhibited to me
her/his__________________________ No ______________, issued on ______________at
_______________ thereon as proof of her identity.

Doc. No._________
Page No. _________
Book No. _________
Series of _________-