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Affidavit of Intent and Consent To Adoption of Child

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(Affidavit of Intent and Consent to Adoption of Child)

REPUBLIC OF THE PHILIPPINES)


Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

JOINT AFFIDAVIT OF INTENT AND CONSENT

We, _____________ and _____________, both Filipinos, of legal age, married and
presently residing at _____________, Philippines, having been duly sworn in accordance with
law, hereby depose and state:

1. That we are the legitimate parents of _____________ who was born on


_____________ in _____________, Philippines.

2. That we have not, at any time abandoned said minor child.

3. That we are unable to support said child and that believing that it would be for
(his/her) own interest and benefit, we, hereby signify our written intent, freely and
voluntarily to have our (son/daughter) _____________ be adopted.

4. That we also signify our written consent, freely, willingly and voluntarily to have
our (son/daughter) _____________ be legally adopted by the spouses
_____________ and _____________ of _____________, Philippines in accordance
with law.

5. That we are ready and willing, freely and voluntarily to abdicate our parental
authority over said child in favor of the spouses _____________ and
_____________, who are _____ and _____ years of age, respectively, and who are
both possessed of the necessary civil and legal rights as well as the financial
capacity to raise, rear and support said child, after the adoption proceeding had been
instituted and an order of adoption be issued.

6. That we execute this affidavit to declare our intention and consent to the adoption of
our (son/daughter) _____________ as well as to the truth of the foregoing facts.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ at


_____________, Philippines.

AFFIANT AFFIANT

(JURAT)

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