AFFIDAVIT TO BE SWORN BY FATHER OR A MOTHER WHO CLAIMS TO BE THE SOLE GUARDIAN OF THE INFANT.

I (full name) __________________________________________________________ of (full address) _______________________________________________________ _____________________________________________________________________ aged ________ years and upwards, make oath and say as follows:-

1) I am the father/mother of (full names of child) _______________________________ born the ____ day of ________________ in the year of __________ I beg to refer to the birth certificate of the said infant upon which, marked with the letter !"#, I ha$e signed my name prior to the swearing hereof

%) I say that I am the sole guardian of the said infant and that: a) there is no &ourt 'rder gi$ing the father/mother or any other person (uardianship o$er the said infant: b) that I ha$e not entered into any arrangement or agreement which has the effect of making, or purports to make the father/mother or any other person guardian of the said child )ointly with me* c) that no other person is a guardian by operation of law*

d) that no other circumstances e+ist whereby there is or may be a guardian

,)

I make this -ffida$it from facts within my own knowledge sa$e where otherwise appears

.worn and declared by the abo$e named __________________________________________________ this ______ day of _________________, %/_____ at ________________________________________ before me (print full name) ____________________________________________________________ ____________________________________ and I know the deponent:_________________________ .ignature of 0eponent _____________________________________ .ignature of 5erson -dministering 'ath/0eclaration and 6elephone 8umber ________________________________________ '11I&I-2 .3-2 '4 .6-75

NOTES -t appropriate places please delete either the word !father# or the word !mother# and make any other amendments or deletions as appropriate 6his document must be sworn or declared before a person authorised by law to administer oaths

NOTES

-11I0-9I6 1

:here a person claims to be the sole guardian of a child and in order to comply with the terms of the .tatus of &hildren -ct, 1;<= it is necessary to complete the attached -ffida$it form >-11 1? 6his should be completed in the presence of a .olicitor or &ommissioner for 'aths 6his -ffida$it should be accompanied by the regular passport application form, -5.1 >where the applicant is resident in the .tate? or -5.% >where the applicant is resident abroad? * the child@s long form birth/adoption certificate and pre$ious passport, if applicable* and, in the case of children born in Ireland on or after 1 Aanuary %//B the 2ong 1orm Cirth certificate or Irish passport of the parent :here the parent is not an Irish citiDen other documents in regard to the parent are reEuired 1ull details on these reEuirements are set out in the notice New Citizenship Changes
effective from 01 January 2005

on this site

_____________ 5assport 'ffice 7ay %//B