Affidavit of Support and Consent

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					                               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.   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

				
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