SPA DSWD Clearance
SPA DSWD Clearance
SPA DSWD Clearance
KNOW ALL MEN BY THESE PRESENTS:
I, SANDIE FERNANDEZ SARINO, of legal age, Filipino, with address at Brgy. Balite,
Villaba, Leyte, do hereby name, constitute and appoint ADAM QUINT, my mother, with address at
Kansas City, to be my true and lawful attorney, for and in my name, place and stead, and for my own
benefit, to do all acts necessary, to wit:
1. To accompany my niece and the child, JAY CHRIS SARINO QUIJOTE, in travelling abroad,
specifically to Kansas City, State of Missouri, U.S.A.;
2. To give consent and permission for any kind of medical care and treatment, and to sign any
papers that are needed to have the above mentioned child travel abroad particularly to Kansas City, State
of Missouri, U.S.A., where his mother, CARIN SARINO, is currently residing but who cannot
accompany the said child due to the fact that said CARIN SARINO had just given birth.
3. To perform any act that is necessary to obtain relief or aid that may benefit the abovementioned
child.
4. Perform any other acts for support, health, and general care of the abovementioned child as may
be required or necessary.
5. That it is not at all my intention of CARIN SARINO to relinquish my full parental rights to the
above mentioned child.
6. To give consent and permission and the authority to sign in my behalf to secure DSWD
clearance allowing said child to travel alone to come to his mother;
With full power and authority to make, sign, seal, execute and deliver any and all documents, and
other writings of whatever nature or kind in connection thereto; and in general, to do all other acts, deeds,
matters, and things whatsoever in furtherance of the power thus granted;
HEREBY GIVING AND GRANTING unto our said attorney full power and authority to do and
perform all and every act requisite or necessary to carry into effect the foregoing authorities, as fully to all
intents and purposes through its authorized representatives might or could lawfully do if personally
present, with full power of substitution and revocation, and hereby ratifying and confirming all that the
said attorneys shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day of August, 2018, at Villaba,
Leyte, Philippines.
SANDIE FERNANDEZ SARINO
Principal
1
` MPD ID No. 0497977
Issued on: April 27, 2018
Issued at: MPD, Manila
SIGNED IN THE PRESENCE OF:
__________________________ _________________________
ACKNOWLEDGMENT
BEFORE ME, a Notary Public for and in the Municipality of Villaba, Province of Leyte,
personally appeared the Principal, SANDIE FERNANDEZ SARINO, who is identified by his
respective competent evidences of identity, together with his instrumental witnesses, known to
me and to me known to be the same persons who executed the foregoing instrument and he
acknowledged before me that the same is his voluntary act and deed and the voluntary act and
deed of the persons represented.
This Instrument relates to a Special Power of Attorney consisting of two (2) pages
including this Acknowledgement, having been signed by the party and his witnesses on each and
every page and sealed with my notarial seal.
WITNESS MY HAND AND SEAL this 20th day of August 2018, at Villaba, Leyte,
Philippines.
NOTARY PUBLIC