AFFIDAVIT

(Support and Consent/Parental Travel Permit)

We, MARY ANN MELEGRITO FRANCISCO AND FERMIN BACCAY MADAMBA Both of
legal age, Both married, Filipino and residents of Flat 10 Langdon Court Craven Park RD.
NW108SP after having been duly sworn to in accordance with law, hereby depose and state:

1. That we are the sole parent of JACOB ALEXANDER F. MADAMBA.

2. That we are giving full consent for our child to travel from the Philippines to United
Kingdom for the purpose of absolutely residency and custody of our child.

3. That the child will leave the Philippines on ___________and will stay in the said place of
destination for absolute custody and stay in the aforesaid country.

4. That we personally guarantee financial support of our child in the course of his travel
and stay outside the Philippines and further guarantee that he will not in any manner
become public wards or burden in United Kingdom or any country en route or to the
Philippines.

5. That this affidavit is executed for the Purpose of attesting to the truth of the foregoing
facts and for whatever legal purposes it may serve period only;

6. That DSWD-NCR will not be held liable for any unforeseen circumstances that may
happen to our child JACOB ALEXANDER F. MADAMBA.

FURTHER AFFIANTS SAYETH NONE.

IN WITNESS WHEREOF, we have hereunto affixed our respective signatures this ____ day
of ___ , 2023at ____________City.

FERMIN BACCAY MADAMBA MARY ANN MELEGRITO FRANCISCO

Father Signature Mother Signature
PHILPASSPORT: P5554539B PHILPASSPORT: P6594871B
Issued on: SEPT 24, 2020 Issued on: March 30, 2021
Issued at DFA Issued at : DFA______________

SUBSCRIBED AND SWORN to before me this __ day of ___, 2023 at the City
of_________, , the affiants exhibiting to me their Government issued IDs written below their
respective names.

Doc. No. NOTARY PUBLIC

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