AFFIDAVIT OF SUPPORT & CONSENTAND SPA:

ISSUANCE OF PHILIPPINE PASSPORT, DSWD CLEARANCE

REPUBLIC OF THE PHILIPPINES ) Consulate General of the Philippines ) s.s. New York, New York )

AFFIDAVIT OF SUPPORT AND CONSENT AND

SPECIAL POWER OF ATTORNEY I / We, ____________________________________________________ of legal age(s), single / married to _________________________________________ citizen(s) of ____________________________________, and with residence and postal address at____________________________________________________________________ hereby declare under oath, that: 1. That we are / I am the father / mother of the minor(s):

NAME AGE

2. That the minor(s) is/are applying for Philippine passport(s) at the Department of Foreign Affairs, in order to join me / us here in the United States;

3. That I am/we are willing and able to support him/her/them while in the U.S.; 4. That _______________________, presently residing at ____________________

_______________ will apply for my child / children’s passport in the Philippines; 5. That _______________________________________________ will accompany my

child /children during their travel from the Philippines to the United States; 6. That I / We also authorize ____________________________, presently residing at

_________________________________________________________ to secure a clearance from the Philippine Department of Social Welfare and Development for my/our unaccompanied minor child / children, who will be travelling to the United States on ____________________;

7. Thay my/our child/children will be staying with me/us at ___________________ _______________________________________________________________;

8. That though the minor(s)’ father/mother is not here present, I am giving consent to said minor(s)’s travel in as much as: (check one that applies)

[ ] Said father / mother has earlier voluntarily and freely given his/her consent, with no condition imposed whatsover, and requested that said consent be relayed to me. [ ] I have exclusive legal custody of minor (see attached divorce decree / death certificate / etc.) [ ] Other_________________________________________________________

9. That I/We assume responsibility for the issuance of the passport and for allowing the trip of said minor(s) and further assume any and all obligations consequent thereto; and

10. That I am /we are executing this Affidavit to attest to the truth of the above statement in connection with said minor’s application for a Philippine passport.

IN WITNESS WHEREOF, I have hereunto set my hand this ______________ at New York City, New York, United States. __________________________ _______________________ FATHER MOTHER