Republic of the Philippines)

)S.S.
)
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AFFIDAVIT OF INTENT AND CONSENT

I, RATCHEL RAMIREZ AGAPEN, Filipino, of legal age, widow and

presently residing at Najma Building, 74 Flat No. 1, Doha, Qatar, having
been duly sworn in accordance with law, hereby depose and state:

1. That I am the biological mother of Jho-anne Pacis Gabriel

who was born on May 26, 2003 in San Agustin, Isabela,
Philippines;

2. That I left the care and custody of my child to spouses

Bonifacio and Anania Gabriel after birth until now;

3. That I am now a widow;

4. That I am unable to support said child and that believing

that it would be for her own interest and benefit, I, hereby
signify my written intent, freely and voluntarily to have my
daughter Jho-anne Pacis Gabriel be adopted;

5. That I also signify my written consent, freely, willingly and

voluntarily to have my daughter Jho-anne Pacis Gabriel
be legally adopted by the spouses Bonifacio Gabriel and
Anania Gabriel of Dabubu Pequeno, San Agustin,
Isabela, Philippines, in accordance with law;

6. That I am ready and willing, freely and

voluntarily to abdicate my parental authority over said
child in favor of the spouses Bonifacio and and Anania,
who are 70 and 54 years of age, respectively, and who
are both possessed of the necessary civil and legal rights
as well as the financial capacity to raise, rear and support
said child, after the adoption proceeding had been
instituted and an order of adoption be issued;

7. That I execute this affidavit to declare my intention and

consent to the adoption of my daughter Jho-anne Pacis
Gabriel as well as to the truth of the foregoing facts;
 IN WITNESS WHEREOF, I have hereunto set my hand this ____ day
of _______ 2019 at _______________________, _______________.

RATCHEL AGAPEN
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______

2019 the affiant is personally known to me and exhibiting to me her
passport no. Ec6487106 issued at Philippine Embassy, Doha, Qatar on
January 2015.