REPUBLIC OF THE PHILIPPINES
)
PROVINCE OF ____________________ )SS
MUNICIPALITY/CITY OF ____________)
IN RE: PETITION FOR ADMINISTRATIVE
DECLARATION OF MINOR (CHILD’S
NAME) AS LEGALLY AVAILABLE
FOR ADOPTION
Petition Control No:
______________________
(NAME OF PETITIONER)
(Designation)
(Name of Agency/Institution)
Petitioner
x-----------------------------------------------------------x
PETITION
(for surrendered child)
Petitioner unto this office most respectfully alleges:
1. That the petitioner is of legal age, Filipino, and a resident of (Address) and is presently
the Head of the (Name of Agency/Institution), a (licensed/accredited child
caring/placing agency) with office address at (address);
2. That the subject child, (Name of Child), (approximately) (age of child), is presently under
the care and custody of (Name of agency/ institution) located at (address of agency/
institution) since (date of admission);
3. That a Social Case Study Report prepared by (Name of Social Worker), an accredited
adoption social worker, copy of which is attached as Annex “A”, made an integral part
hereof shows that (indicate circumstances of referral and admission to the
agency/institution);
4. That
counselling
and
services
had
been
provided
to
the
birthparent/s/grandparent/s/sibling/s/legal guardian/s to capacitate them to care for the
subject child. However, the birthparent/s/grandparent/s/sibling/s/legal guardian/s
remained firm on their decision to place the subject child for adoption. The content and
meaning of the Deed of Voluntary Commitment was explained to them and confirmed that
they have understood its content by signing the DVC on (date of signing), copy of the
DVC and the Certificate of Authority for a Notarial Act hereto attached as Annexes “B”
to “B-1”;
5. That the subject child’s most recent photograph and a photograph upon admission to the
center are attached as Annexes “C” to “C1”;
6. That the social worker facilitated securing the subject child’s Certificate of Live Birth on
(date) to ascertain his/her identity, copy of the Certificate of Live Birth is attached as
Annex “D”;
7. (Include other annexes/information, if necessary, such as Affidavit/s, Death
Certificate of parent/s (if applicable), Assessment Report of subject child’s
biological family/relatives, Consent of birthfather, etc.);
8. That the subject minor, (name of child), was voluntarily committed by his/her parent/s for
(number of years/months) and had not retracted their decision since then;
9. That the subject minor being a voluntarily committed child, needs to be declared legally
available for adoption.
WHEREFORE, premises considered, it is most respectfully prayed to this Office that a
Certificate be issued declaring the child, (name of minor), as legally available for
adoption.
April 2, 2009, Quezon City, Philippines.
HEAD
Name and Signature of Petitioner
SUBSCRIBED AND SWORN to before me this ______ day of _____________
20____ in _________________________. Petitioner exhibited to me her valid ID
____________ with no. ______________ issued on ___________ at ______________.
NOTARY PUBLIC
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