DSWD PMB GF 002 - REV 02 - Affidavit of Undertaking

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DSWD-PMB-GF-002 | REV 02 / 30 SEPT 2022

AFFIDAVIT OF UNDERTAKING

I/We ___________________________________ and


_______________________________ of legal age, _______________(civil status)
________________(nationality) and a resident of
____________________________________________________ and with Foster Care
License No.___________________ valid on:____________________ with Foster Placement
Authority No:____________, valid on: _____________________ and tel.
no.___________________ after having been sworn to in accordance with the law do hereby
depose and state;

1. That I am/we are the foster father/mother and /or person exercising parental authority
over minor(s) _____________________________,
_________________________________.

2. That the child/children will travel to _______________________ (country) for the


following reason/s
_______________________________________________________.

3. That the mentioned child/children will be leaving on


_____________________________ and will be staying in the said country for a period
of _____________________________ to be accompanied
by________________________________________(name of companion) and the
_____________________ (relationship to minor).

4. That the travel expenses and other needs of the child/children will be shouldered by
__________________________________________ (name & relationship to the
child/children)

5. That I/We take full responsibility in personally presenting the child/children within 5
days upon return from the travel to the DSWD Field Office _____ for post-travel
assessment of the social worker pursuant to A.O 12, series of 2017 or the Omnibus
Guidelines on Minors Travelling Abroad.

6. That this affidavit was executed for the purpose of attesting to the truth of the foregoing
facts and for whatever legal purpose it may serve and

IN WITNESS HEREOF, I have hereunto set my hand this ___th day of _____, 20___ in
_________________, Philippines.

FATHER MOTHER

Subscribe and sworn to before me……………..)


Notary Public

Date__________________
Doc. No_____________
Page No.____________
Book No.____________
Series ______________

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DSWD Field Office III, Government Center, Maimpis, City of San Fernando, Pampanga, 2000 Philippines
Website: www.fo3.dswd.gov.ph Tel Nos.: (045) 961-2143

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