REPUBLIC OF THE PHILIPPINES)

BAGUIO CITY
) S. C.

AF F I D AV I T O F

CONSENT

I, ESPIE VITAL CUSPAO, of legal age, single, Filipino citizen with

residence and postal address at Nursery Boulevard, Masbate City, after
having been duly sworn to in accordance with law, do hereby depose and
state that:
1. I am the biological mother of one ROSELYN VITAL CUSPAO
who was born on January 5, 2014 in Masbate City;
2. I was not married when I gave birth to ROSELYN VITAL
CUSPAO;
3. My friends, SPS. ANNIE S. GULTIA and ANTHONY A.
GULTIA, had helped me greatly in raising my minor child and had
expressed their desire to adopt my said child;
4. I am not insane, nor intemperate, nor have I abandoned said minor
child. I have full knowledge of the intention of SPS. ANNIE S.
GULTIA and ANTHONY A. GULTIA to adopt my minor child
and having the best interest of my child in mind, I have consented
to the adoption;
5. I am aware of the fact that once ROSELYN VITAL CUSPAO will
be adopted, I shall lose ALL parental authority and that she will
become the legal child of SPS. ANNIE S. GULTIA and
ANTHONY A. GULTIA;
6. I am executing this AFFIDAVIT OF CONSENT freely and
voluntarily to attest to the truthfulness of my foregoing statements
and circumstances; to prove and show that I am giving my
consent to the adoption of my minor child ROSELYN VITAL
CUSPAO by SPS. ANNIE S. GULTIA and ANTHONY A.
GULTIA and for all other legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day
of July 2015 at Baguio City, Philippines.

ESPIE VITAL CUSPAO

Affiant

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SUBSCRIBED AND SWORN TO BEFORE ME this 4 th day of

January 2017 at Masbate City. The Affiant exhibited to me her BIR TIN ID
Card with TIN ID 293-464-775-000 issued in Masbate City on September
14, 2011 indicated below her name and signature. She acknowledged to me
that the same is her free and voluntary act or deed.
WITNESS MY HAND AND SEAL.

ATTY. HILDA ANGELIE BERNAL

Notary Public for Masbate City
Corner. Rosero & Quezon Streets,
Masbate City Masbate
IBP No. 812888; 01/04/2017
PTR No. 1218888; 01/04/2017
Roll No. 88811; 05/05/2005
MCLE No. 888808
Doc. No.___2_;
Page No. __5__;
Book No.__1__ ;
Series of 2017_

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