DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE __________

Name of Minor: _____________________________________________________________
Age: _________________  Date of Birth: ________________________________________
Address: __________________________________________________________________
Local Phone No.: _____________________  Phone No. Abroad: _____________________
Address Abroad: ___________________________________________________________
Status of Birth: __________________  	Legitimate              Illegitimate        

If adopted or under Legal Guardianship, please indicate Special Proceeding No.

PARENTS:

Father: ____________________ Age: ____ Occupation: ____________ TIN: ___________
Address: __________________________________________________________________
Mother: ____________________ Age: ____ Occupation: ____________ TIN: ___________
Address: __________________________________________________________________

TRAVELING COMPANION:

Name of Traveling Companion: ________________________________________________
Address: __________________________________________________________________

DESTINATION: ____________________________________________________________
Length of Travel (Inclusive Date): ______________________________________________

Reason for Travel Abroad (Reason/s for bringing minor)
_________________________________________________________________________
_________________________________________________________________________

Reasons why parents or legal guardian cannot accompany minor
_________________________________________________________________________
_________________________________________________________________________

Place where the minor intends to stay during his/her travel and with whom (please indicate names, complete address and phone numbers).
_________________________________________________________________________
_________________________________________________________________________

I hereby certify that the information given above are true and correct.  I further understand that any misrepresentation that I may have made will subject me to criminal and civil action provided under existing laws.

_________________					_______________________
Date						Signature Over Printed Name
_______________________
Relationship to Minor
_________________________________________________________________________
This portion is to be filled up by the Social Worker

Remarks to Applicable Documents
  Travel Clearance for Minors Traveling Abroad
Date Reviewed: ______________________		Reviewed by: _____________________
							Designation: ______________________