REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAGAYAN ) S.S

MUNICIPALITY OF PIAT )

AFFIDAVIT OF SUPPORT AND CONSENT TO TRAVEL

I, LORNA TOMAS-AQUINO, of legal age, Filipino, married and presently residing at

Poblacion 1, Piat, Cagayan, after having been duly sworn to in accordance with law, depose and
state:
1. That I am the biological mother of Janina Dane Tomas Aquino, a minor born on December 31,
2001 in Tuguegarao City, Cagayan.

2. That said child will travel to Hong Kong as tourist together with my sister, Josefa Carungui;

3. That said child will be leaving in March 2017 and will stay in the said country for a period of
three(3) to four (4) days and will be taken cared of by said sister;

4. That I cannot personally travel with my child due to the fact that I have a lot of concerns to attend
to here in the country which are equally important;

5. That I am giving my full consent for the minor child to travel abroad to be accompanied by my
said sister;

6. That I personally guarantee the financial support of the said child in the course of her travel and
stay outside the Philippines, and further, guarantee that she will not in any manner become a
burden to the Philippine and to the Hong Kong Government.

7. That I am executing this affidavit in connection with my child application for a passport at the
Department of Foreign Affairs, and for whatever legal intent and purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of Janury 2017, in
Piat, Cagayan, Philippines.

LORNA TOMAS-AQUINO

Affiant

PHILPOST ID No. PAN A28150111 436 B

SUBCRIBED AND SWORN TO, before me, 16th day of Janury 2017, in Piat,
Cagayan, Philippines, affians exhibiting to me her valid proof of identification.

No Available Notary Public in the Municipality.

ATTY. CARMELO O. VILLACETE

Municipal Mayor
Administering Officer