REPUBLIC OF THE PHILIPPINES)
MAKATI CITY ) S. S.
AFFIDAVIT OF CONSENT FOR LEGAL ADOPTION
I, JARLIE S. GULTIA, Filipino citizen, of legal age, single and a resident of # 1161 Saracim
St., Brgy. Rizal, Makati City, Metro-Manila, after having been duly sworn to in accordance with
law, do hereby depose and say: that-
1. I had lived with SENA MARIS G. KHAW without the benefit of a lawful marriage since
year 2011 and that out of that relationship we begot a child named, YHEN VENIQUE
KHAW GULTIA who was born on 01 August 2013 at Global Birthing Home B58, L42, Ph2,
Pinagsama Villgae, Taguig City, Metro-Manila;
2. Due to irreconcilable difference, I and SENA MARIS G. KHAW in the year 2016 lives
separately from each other and that she is in custody of our child up to the present;
3. SENA MARIS G. KHAW sought to legally adopt our child and as such I interpose no
objection and give my full consent on the intended legal adoption of YHEN VENIQUE
KHAW GULTIA in accordance with our existing laws;
4. I am executing this affidavit freely and voluntarily without force or intimidation upon my
person nor a benefit of gain whatsoever or to violate our existing laws;
5. I further execute this affidavit for all legal intents and purposes this may serve best;
AND FURTHER AFFIANT SAYETH NAUGHT.
JARLIE S. GULTIA
Affiant
SUBSCRIBED AND SWORN to before me this _________ day of ________________ at
Makati City, Metro-. Affiant exhibited to me his valid proof and evidence of identity his
Philippine Passport with number P1809348A.
Doc. No. __________
Page No. __________
Book No. __________
Series of 2017.
