Republic of the Philippines )

Las Pias City

)

S.S.

Affidavit of Consent
I, ______________________,Filipino, of legal a
g e , single/married to _______________ and resident of __________
_____________, after having duly sworn to in accordance with law,
voluntarily depose and say:
1 . T h a t I a m a n a p p l i c a n t fo r e l e c t r i c s e r v i c e i n
s u b j e c t p ro p e r t y w i t h M E R A L CO u n d e r A p p l i c a t i o n
_ _ _ _ _ _ _ _ _ , a c o py o f t h e d u l y a c c o mp l i s h e d M E R A L CO
father/mother of minor(s) ___________________________
______________________________________________________________
is/are ______________ years old;

the
No .
the
___
who

2 . T h a t s a i d m i n o r ( s ) i s / a r e a p p l y i n g fo r a
P h i l i p p i n e p a s s p o r t i n c o n n e c t i o n with his/her forthcoming trip to
he _______________________________;
3.That said minor(s) will be accompanied by
h i s / h e r : _________________________________________________________
__ (relationship and name of person accompanying minor(s));
4.That though the minors father/mother is not
h e r e p r e s e n t , I a m g i v i n g consent to said minors travel in as much
as: ______ said father/mother has earlier voluntarily and freely given
his/her consent, with no condition imposed whatsoever, and requested
thatsaid consent be relayed by me. ______ I have exclusive legal custody of
minor (see
attached
divorcedecree
/
death
certificate
/
etc.) ___________________________________________________________ _____
___________________________________________________ (state
appropriate
reason)
5.That I assume responsibility for the issuance
o f t h e p a s s p o r t a n d f o r allowing the trip of said minor and further
assume any and all obligations consequent thereto; and6 . T h a t I a m
executing this Af davit to attest to the truth of the
a b o v e statement in connection with said minors application for a Philippine
passport.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________ in
the City of Honolulu. ________________________________
AFFIANT