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AFFIDAVIT TO BE SWORN BY FATHER OR A MOTHER WHO CLAIMS TO BE THE

SOLE GUARDIAN OF THE INFANT.

I (full name) __________________________________________________________

of (full address) _______________________________________________________

_____________________________________________________________________

aged ________ years and upwards, make oath and say as follows:-

1) I am the father/mother of (full names of child) _______________________________

born the ____ day of ________________ in the year of __________ I beg to refer to the birth

certificate of the said infant upon which, marked with the letter !"#, I ha$e signed my name prior to

the swearing hereof

%) I say that I am the sole guardian of the said infant and that:

a) there is no &ourt 'rder gi$ing the father/mother or any other person uardianship o$er the said

infant:

b) that I ha$e not entered into any arrangement or agreement which has the effect of making, or

purports to make the father/mother or any other person guardian of the said child ointly with me*

c) that no other person is a guardian by operation of law*

d) that no other circumstances e+ist whereby there is or may be a guardian

) I make this ffida$it from facts within my own knowledge sa$e where otherwise appears

.worn and declared by the abo$e named __________________________________________________

this ______ day of _________________, %_____ at ________________________________________

before me (print full name) ____________________________________________________________

____________________________________ and I know the deponent:_________________________

.ignature of 0eponent 'I&I2

_____________________________________ .32 '4

.ignature of 5erson dministering 'ath/0eclaration .675

and 6elephone 8umber ________________________________________

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NOTES

t appropriate places please delete either the word !father# or the word !mother# and make any otheramendments or deletions as appropriate

6his document must be sworn or declared before a person authorised by law to administer oaths

NOTES I09I6 1

here a person claims to be the sole guardian of a child and in order to comply with

the terms of the .tatus of &hildren ct, 1; 1?

6his should be completed in the presence of a .olicitor or &ommissioner for 'aths

6his ffida$it should be accompanied by -

the regular passport application form, 5.1 >where the applicant is resident in

the .tate? or 5.% >where the applicant is resident abroad? *

the child@s long form birth/adoption certificate and pre$ious passport, if

applicable* and,

in the case of children born in Ireland on or after 1 Aanuary %B the 2ong

orm Cirth certificate or Irish passport of the parent here the parent is not

an Irish citiDen other documents in regard to the parent are reEuired ull

details on these reEuirements are set out in the notice New Citizenship Changes

effective from 01 January 2005on this site

_____________

5assport 'ffice

7ay %B

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