UNDERTAKING AND OATH REGARDING COMPLETE AND ACCURATE

INFORMATION ON PROSPECTIVE ADOPTIVE PARENTS

We,___________________________, residents of _________________________,
are applying to adopt from the Philippine program.


We acknowledge the necessity to ensure that complete and accurate information is
given regarding the prospective adoptive parents and their children, the following
are true and accurate statements, as verified by our initials and sworn signature:


1. All information provided about ourselves, our biological/adoptive child/ren
and the other family members are complete and accurate,


2. We have not made any or previous pending effort/s to bring a child/ren from
the Philippines (e.g. through medical, tourist, student or sponsor visa),


3. We have not and will not make any effort to adopt a child/ren within the
Philippine court system.



Adoptive Father Signature: ________________________ Date: __________

Adoptive Mother Signature: ________________________Date: __________





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Acknowledged before me this ________day of ___________________, 20 ____ in

State/Province of ________________________ Country of __________________.




Notary Public Name: _________________________

Notary Public Signature _________________________

Notary Publics Country of Residence _________________________

My Commission Expires _________________________



My Public Seal