Republic of the Philippines )

City of Cagayan de Oro )s.s.

AFFIDAVIT

I, X, 34 years old, Filipino citizen and a resident of Nazareth, Cagayan

de Oro City, after having been sworn in accordance with law, hereby depose
and say:

That my daughter Y is a bona fide holder of a valid Philippines

Passport issued by the Department of Foreign Affairs, Manila Consular Office;

That her Philippine Passport will be expiring today, November 29,

2012, and I intend to cause the renewal of her passport;

That the DFA prescribes an additional requirement for her passport

renewal ---- that is, an Affidavit of Support and Consent of at least one parent;

That I as her mother, hereby confirm that I am the one who is giving
her support and I hereby give consent to her travel abroad in the near future;

That I execute this Affidavit freely and voluntarily to attest to the

foregoing facts to comply with the requirement of the DFA and for whatever
legal purpose this may serve.

FURTHER, Affiant sayeth none.

IN WITNESS WHEREOF, I hereunto set my hand this 29 th day of

November 2012 at Cagayan de Oro City, Philippines.

X
Affiant

SUBSCRIBED AND SWORN to before me this 29th day of November

2012 at Cagayan de Oro City, Philippines, Affiant exhibiting to me her SSS
I.D. No. 111 as competent proof of identity.