AFFIDAVIT OF PARENTAL CONSENT TO TRAVEL OF A MINOR WITHOUT ADULT SUPERVISION

REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF ________ ) S.S.

§ I. THE AFFIANT

I, ________, of legal age, Filipino, with civil status of ________, and a resident of ________, bearing ________ with Identification Number ________ issued at ________ on ________, after having been duly sworn to in accordance with law, do hereby depose and state:

§ II. PARENTAL AUTHORITY OVER THE MINOR

1. That I am the ________ who exercises sole parental authority and substitute parental authority over the herein named minor child, pursuant to Articles 209, 211, 214 and 216 of the Family Code of the Philippines (Executive Order No. 209, as amended);

2. That the minor child is described as follows:

2.1. Full Name: ________;
2.2. Sex: ________;
2.3. Date of Birth: ________;
2.4. Place of Birth: ________;
2.5. Nationality: ________;
2.6. Passport/Identification Number: ________;

3. That the relationship between the affiant and the minor is evidenced by ________ (e.g., PSA-issued Certificate of Live Birth, Solo Parent Identification Card under Republic Act No. 8972, as amended by Republic Act No. 11861, or court-issued letters of guardianship);

§ III. GRANT OF CONSENT TO TRAVEL

4. That I hereby freely, voluntarily and expressly GIVE MY FULL CONSENT and AUTHORITY for the above-named minor child to travel ________ to ________ for the period commencing on ________ and ending on ________, without the presence or supervision of an accompanying adult, for the purpose of ________;

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6. That the minor child shall be received and/or met at the destination by ________, whose relationship to the minor is ________ and whose contact details are ________;

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§ IV. EMERGENCY CONTACT INFORMATION

8. That in case of emergency, the parent/person exercising parental authority may be reached at:

Name: ________
Address: ________
Mobile/Telephone Number: ________
Email Address: ________

9. That any personal information disclosed herein is processed solely for the lawful purpose of facilitating the travel and clearance of the minor, in accordance with Republic Act No. 10173 (Data Privacy Act of 2012);

§ V. ATTESTATION

10. That I am executing this Affidavit to attest to the truth of the foregoing and for whatever legal purpose this may serve, and that all statements herein are true and correct of my own personal knowledge and based on authentic records.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ at ________, Philippines.

__________________________________
________
Affiant

ACKNOWLEDGMENT / JURAT

SUBSCRIBED AND SWORN to before me this ________ at ________, Philippines, affiant exhibiting to me her/his competent evidence of identity consisting of ________ with number ________ issued on ________ at ________.

__________________________________
NOTARY PUBLIC

Doc. No. ________;
Page No. ________;
Book No. ________;
Series of ________.