AFFIDAVIT OF VOLUNTARY APPOINMENT

OF LEGAL GUARDIANSHIP

KNOW ALL MEN BY THESE PRESENTS:

I, , of legal age, married, Filipino and residing at Al Athir District,

Dammam, Kingdom of Saudi Arabia, states that:

1. I am the father of, minor, born on the May 7, 2015, a Filipino, and resident
of Block 1, Lot 3, Victoria Townhouse, Brgy. Pook, Sta. Rosa, Laguna ,
Philippines;

2. I am the father of, minor, born on the October 24, 2005, a Filipino, and
resident of Block 1, Lot 3, Victoria Townhouse, Brgy. Pook, Sta. Rosa,
Laguna, Philippines;

3. The above-named children has been under the care and custody of my
wife, , of legal age and a resident of the Block 1, Lot 3, Victoria
Townhouse, Brgy. Pook, Sta. Rosa, Laguna, Philippines, Philippines
since the children’s birth;

4. The family conjugal dwelling is Block 1, Lot 3, Victoria Townhouse,

Brgy. Pook, Sta. Rosa, Laguna, Philippines;

5. has decided to leave the family conjugal dwelling and abandoned her
parental responsibilities to our children;

6. I am a working abroad as an Overseas Filipino Worker, specifically in

Dammam, Kingdom of Saudi Arabia;

7. I appoint the legal guardianship and authorize to exercise any and all of
my rights and responsibilities regarding the care, custody, and control of
my child, , to my mother-in-law and grandmother of the latter,
___________________, of legal age, Filipino, married, and residing at
__________________________________________, Sto. Tomas,
Batangas, for the period that I am working as an Overseas Filipino
Worker;

8. My child, , shall reside with the designated guardian,

______________________________ at our vacation house at Casa
Isabel, Sto. Tomas, Batangas;

9. The designated guardian, __________________________, shall have the

following authority:

a) SOLE and residential custody of the minor child until the he finishes
a Bachelor’s Degree;
b) to approve medical treatment of any kind or type or to disapprove
the same within the bounds of the law;
c) to designate schooling for the minor child, and access to any and
all of his educational records; and,

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 d) to generally act in loco parentis to any matters with regard the
minor child’s best interest.

10. While abroad, I will leave and send money for financial support of my
child, , through ___________________________, which is needed for his
daily needs and sustenance as well as his education;

11. I appoint the legal guardianship and authorize to exercise any and all of
my rights and responsibilities regarding the care, custody, and control of
my child, , to my sister, ____________________________, of legal age,
Filipino, married, and residing at
__________________________________________, Iloilo, Philippines, for
the period that I am working as an Overseas Filipino Worker for the
period that I am working as an Overseas Filipino Worker;

12. The designated guardian, __________________________, shall have the

following authority:

a) SOLE and residential custody of the child, until the she finishes a
Bachelor’s Degree;
b) to approve medical treatment of any kind or type or to disapprove
the same within the bounds of the law;
c) to designate schooling for the child, and access to any and all of
her educational records; and,
d) to generally act in loco parentis to any matters with regard the
child’s best interest.

13. My child, , shall reside with the designated guardian,

______________________________ at
___________________________________________________________;

14. While abroad, I will leave and send money for financial support of my
child, , through ___________________________, which is needed for his
daily needs and sustenance as well as his education;

15. I am issuing this affidavit for all legal intents and purposes it may serve;
and,

16. I hereby warrant, undertake, affirm and confirm that the above
stipulations are true and correct as far as my personal knowledge and
belief is concerned.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____ day of _____________________ in Al Athir District, Dammam, Kingdom
of Saudi Arabia.

Affiant
Passport No. ________________

Signed in the presence of:

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___________________________ & __________________________
ACKNOWLEDGMENT

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