AFFIDAVIT OF SUPPORT AND CONSENT AND SPECIAL …

1 AFFIDAVIT OF SUPPORT AND CONSENT and SPECIAL POWER OF ATTORNEY I, _____ of legal age, Filipino single/married to _____, with residence/postal address at _____ _____, hereby declare under oath: THAT 1. I am/We are the father and/or mother of the minor(s): Name Age 2. Said minor/s is/are applying for Philippine passport/s at the Department of Foreign Affairs; 3. I am/We are appointing _____, presently residing at _____ to accompany my/our child/children in applying for a passport at the _____; 4. I/We authorize _____, presently residing at _____ to secure a clearance from the Department of Social Welfare and Development for my/our child/children, who will be travelling to _____ on _____; 5. I/We authorize _____, presently residing at _____ to accompany my/our child/children during his/her/their travel to _____; 6. I am/We are willing and able to SUPPORT my/our child/children during the said travel; 7.

2 On the said travel, my/our child/children will be staying at _____; 8. Though the father/mother of said child/children is not here present, I am giving CONSENT to the above acts in as much as: (check one that applies) [ ] said father/mother has earlier voluntarily and freely given his/her CONSENT , with no condition imposed whatsoever, and requested that said CONSENT be relayed by me. [ ] I have exclusive legal custody of minor (single parent; see attached divorce papers/death certificate of spouse) [ ] _____ 9. I/We assume responsibility for the issuance of the passport and for allowing the trip of the said minor/s and further assume all obligations consequent thereto; and 10. I/We am/are executing this AFFIDAVIT to attest to the truth of the above statements and for whatever legal purpose this may serve. IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this _____ in New York City, New York, United States. _____ FATHER _____ MOTHER