AFFIDAVIT OF CONSENT I, _______________________________, Filipino, of legal age, single/married to __________________________________ and resident of ______________________ _____________________________________, after having duly sworn to in accordance with law, voluntarily depose and say: 1. That I am the father/mother of minor(s) _________________________________ _________________________________________________________________ _____________ who is/are ________________________ years old; 2. That said minor(s) is/are applying for a Philippine passport in connection with his/her forthcoming trip to the ________________________________________; 3. That said minor(s) will be accompanied by his/her: _________________________________________________________________ (relationship and name of person accompanying minor(s)); 4. That though the minor’s father/mother is not here present, I am giving consent to said minor’s travel in as much as: ______ 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 (see attached divorce decree / death certificate / etc.) ______ ___________________________________________________________ ____________________________________________________________ (state appropriate reason) 5. That I assume responsibility for the issuance of the passport and for allowing the trip of said minor and further assume any and all obligations consequent thereto; and 6. That I am 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 ___________ in the City of New York ________________________________ NAME OF ACCOMPANYING ADULT ______________________________ AFFIANT