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Application for Inter-Country Adoption
ICAB adoption application form for inter-country adoption
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: ICAB Form No.1
March 2007
Republic of the Philippines
Inter-Country Adoption Board
No. 2 Chicago cor Ermin Garcia Streets
Barangay Pinagkaisahan, Cubao, Quezon City
APPLICATION FOR INTER-COUNTRY ADOPTION
Greetings!
We/I
______________________________________,
_____________
years
of
age,
_____(citizenship)__________
and
_______________________,
___________
years
of
age,
_____(citizenship)__________
residing
and
with
postal
address
at
_______________________________________________________________________________ hereby apply for
the adoption of a Filipino child/children and state the following:
Part 1. Undertaking
Please tick off.
/ /
That we/I are/am qualified to be adoptive parents under our national laws;
/ /
That we/I have the capacity act and to assume all rights and responsibilities of parents
under our national laws;
/ /
That we/I have not been convicted of a crime involving moral turpitude;
/ /
That we/I am capable of providing support and proper physical, social and psychological
care to all of our children including the child/children we intend to adopt;
/ /
That in the event of disruption of the pre-adoptive placement, we/I shall undertake the
responsibility of assuming the airfare of the child and traveling companion and miscellaneous
expenses that may be incurred in connection with child’s return to the Philippines;
/ /
That we/I shall file the petition for the adoption with the proper court or tribunal in our
country not later than six (6) months after the termination of the pre-adoptive placement;
/ /
We/I agree to uphold the basic rights of the child under our/my national laws, and the
Child and Youth Welfare Code of the Philippines (PD 603) as well as the UN Convention on the
Rights of the Child;
/ /
That we/I agree to abide by the Implementing Rules and Regulations promulgated by the
Inter-Country Adoption Board; and
/ /
That we/I did not in any manner try to induce, coerce or influence the biological
parents/guardians/child caring or placing agency in favor of this application.
Page 1 of 4
Part 2. Information and Personal Data of Applicants for Inter-Country Adoption
(For PAPs to fill in themselves)
I. Identifying Data
Male Applicant / Husband
Female Applicant / Wife
Male Applicant / Husband
Female Applicant / Wife
Name
Age
Date of Birth
Place of Birth
Nationality / Citizenship
Address / Residence
Highest Educational Attainment
Health Status, specify presence
of disability if any
Marital Status
If married, date and place of
marriage
Date of previous marriage, if
any, and manner of termination
Military Service, if any
Year
Branch
No. of years
Hobbies and Interests
Membership in
Association/Clubs/Organizations
II. Economic Data
Present Occupation or
Employment
Name of Employer
Business Address
Telephone Number
Salary per Month (in US $)
Income other than salary,
specify
Insurance
Savings
Real Properties
Page 2 of 4
III. Family Composition
A. List of all individuals living with applicants in present address.
Name
Relationship
Age
Date of
Birth
Sex
Educational
Attainment
Physical, Mental
status; specify
disability, if any
B. List of all children of applicants living away from them, if any.
Name
Where
living/with
whom living
Age
Date of
Birth
Sex
Educational
Attainment
Physical, Mental
status; specify
disability, if any
IV. We/I have applied to adopt a child with (agencies and/or other countries) and the status of our
application/s are.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
V. We/I decided to apply for a Filipino child because
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
VI. We feel our family can care for child/children (include age, sex, physical, mental and emotional
characteristics, etc.) who is/are
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
VII. We/I are childless because
__________________________________________________________________________________
__________________________________________________________________________________
VIII. Our/My experience in caring for children
__________________________________________________________________________________
Page 3 of 4
__________________________________________________________________________________
__________________________________________________________________________________
IX. Our/My experience of being cared for by our/my parents are
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
X. If for some reasons at certain times, we cannot attend personally to the needs of the child, we
have the following alternative provisions:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
XI. Our reactions to contact after adoption of the child/children by the Department of Social
Welfare and Development, Inter-Country Adoption Board, or any agency involved in this adoption
are:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Oath or Affirmation of Deponent
We/I swear (affirm) that I have read and understood the undertaking and attest that the
contents and statements in this application are true and correct.
Signature of Deponent(s)
__________________________________
_________________________________
SUBSCRIBED AND SWORN to (affirmed) before me this _________ day of ______________,
__________ at _______________________________________________________________.
__________________________________________
Name / Title of Officer Administering Oath
My commission expires on: ________________
___________________________
Note: Pursuant to Section 29 of the Rules and Regulations on Inter-Country Adoption, the following fees shall
be paid to ICAB:
1. Filing Fee – Two Hundred US Dollars (US $200) upon application.
2. Processing Fee – Two Thousand US Dollars (US $2000) upon acceptance of the matching proposal for
processing and operational expenses of the inter-country adoption programs and other charges and
assessment for child care and placement programs and services
3. Child Care Support Fund – One Thousand US Dollars (US $1,000)
Page 4 of 4
