Republic of the Philippines )

City of _______________ ) S.S.

x- - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF CONSENT

I, ___________________, of legal age, married, Filipino, and a resident of

_______________________, after having duly sworn to in accordance with law hereby
depose and state:

1) That I am the biological father of _____________who is presently living with her

mother ___________at _____________;

2) That I have no opposition and I hereby give my consent to my son

________________________ to his intention to leave the country together with his
mother and to live in _____________;

3) That I am executing this affidavit to attest to the truth hereof and for whatever
legal purpose this may deem worth.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

__________________ here at ___________________.

___________________________
Affiant

SUBSCRIBED AND SWORN TO before me this

________________________here at _____________________.

Notary Public

Doc. No. ________

Page No. ________
Book No. _______
Series of 200__