Republic of the Philippines)

City of Cebu ) S.S.

AFFIDAVIT OF CONSENT
I, SAM CONCEPCION, of legal age, Filipino, married to Faye Lee-
Concepcion, and presently residing at Blk. 6, Lt. 32, Brgy. Tisa, Cebu City,
after being duly sworn to in accordance with law do hereby depose and
say:
1) That I am the father of minor child, KATHRYN CONCEPCION born
on April 14, 2001;
2) That I am giving my consent for my child to travel abroad to be
accompanied by my wife, Faye Lee;
3) That my wife and I are sponsoring her trip and are financially
capable to support her stay abroad;
4) That I guarantee that she will not violate any existing laws of their
country of destination; and
5) That I am executing this affidavit in connection with my child’s
application for a passport at the Department of Foreign Affairs
and/or travel clearance from the Department of Social Welfare and
Development for their travel abroad.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 25th
day of November 2017 at Cebu City, Philippines.

Thumb Mark affixed by SAM CONCEPCION, in the presence of:

SCARLET SNOW, who is currently residing in Tres de Abril Village, Punta

Prinsesa, Cebu City; and PETMALU LODI, who is currently residing in
123 Bldg., Brgy. Basak San Nicolas, Cebu City; and the undersigned
notary public.

1|Page
SCARLET SNOW PETMALU LODI
Witness Witness

SUBSCRIBED AND SWORN TO before me, this 25th day of November,

2017, in the City of Cebu by SAM CONCEPCION, with Voter’s ID no.
07301234, issued on January 17, 2016 at Cebu City, known to me as the
same person who personally signed the foregoing instrument before me
and avowed under penalty of law to the whole truth of the contents of said
instrument.
WITNESS MY HAND AND SEAL this 25th day of September 2017 in Cebu
City, Cebu.

Doc. No.: MARLOU ARIZALA

Notary Public of Cebu City, San
Page No.:
Fernando and Carcar, Philippines
Book No.: Commission No. 09-56 UNTIL 12/31/18
RM. 501, SM Seaside, Cebu City
Series of 2017 Roll of Attorney’s No. 87753
IBP No. 46637, Cebu City, 01/16/17
PTR No. 0097621, Cebu City, 01/06/17

2|Page