________________________________ ) S. S.
________________________________ )
AFFIDAVIT OF SUPPORT AND CONSENT
(Name of child/children)
citizen(s) of the _____________________________, of legal age(s), and resident(s) of ___________________________________________________, after having been duly sworn to in accordance with law, do hereby depose and state:
1. That I am/we are giving full consent and authority to _____________________________ to apply for passport(s) with the Office of Consular Affairs of the Philippine Department of Foreign Affairs and to apply for appropriate visa(s) with the U.S. Embassy in Manila on behalf of my/our child/children:
________________________________________________________________________________________________________________________________________________
2. That I am/we are giving full consent for my/our child/children to travel from the ______________________________ to the ____________________________________
[ ] alone and unaccompanied [ ] with traveling companion, _________________
_____________________, who is my ________________________________________;
3. That I am/we are giving consent to the guardian to procure tickets for the travel of my/our child/children;
4. That I am/we are willing and able to maintain and support my/our child/children financially and guarantee that he/she/they will not become a public charge or burden during his/her/their stay in the United States.
IN WITNESS WHEREOF, I/we have hereunto set my/our hand this ________________
day of _______________ 20_____ at ______________________.
___________________________________
Signature of Parent(s)
Affiant
SUBSCRIBED AND SWORN to before me this _______ day of ___________________
at _____________________________.
Doc. No.: _________
Service No.: _______
Series of 20________
Fee Paid: __________
O.R. No.: _________
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