Questionnaire for Relative Adoption Applicants

1. Name of Child/Children to be adopted:

2. Date/s of Birth

3. Birth Status: [ ] Legitimate [ ] Illegitimate [ ] Full Orphan [ ] Half Orphan

(both birthparents (one of the birthparents
deceased) deceased)
4. Name of Birth Parents: Father –
Mother –

5. Address of Birthparents

6. Occupation of Birth Parents

7. Income of Birth Parents

8. Siblings of the child to be adopted (please state their names, gender, age, and attitude towards their
sister’s/brother’s adoption)

9. Does/Do the child/ren live with the parents? [ ] Yes [ ] No

10. Does/Do the child/ren live with persons other than their parents? [ ] Yes [ ] No
11. Does/Do the child/ren live with others (custodians/guardians) [ ] Yes [ ] No
12. Please specify name and relationship of children to the custodian/guardian.

13. Address of Child (Give the most complete address and if possible, contact number – telephone,
cellphone, fax number, email, etc.)

14. Is/Are the parents of the child/ren in touch (visit, write, phone) with the prospective adoptee/s?

15. Full name of the applicants Male: Female:

16. Birth date Male: Female:

17. Ethnic Origin Male: Female:

18. Place of Birth Male: Female:

19. Civil Status Male: Female:

20. Current Citizenship Male: Female:

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21. Name of Employer, position, length of employment of the applicants
Male :

Female :

22. Annual Income Male: Female:

23. Number of Children of prospective adoptive parents (indicate if living with them, their ages, and civil
status).

24. Attitude of applicant’s biological/adopted child/ren towards the adoption plan.

25. Other individuals who reside in the household (names; birthdate; relationship to applicants; attitudes
towards the adoption plan; permanently or temporarily residing with applicants; contribution, if any, to the
family income).

26. Reason/s or motivation/s for adoption.

27. Applicant/s’ relationship to identified children to be adopted.

a. Please describe how you are exactly related to the child. (Provide a genogram/family tree tracing
our common ancestry with the prospective adoptee)
b. Kindly provide us with a Certified True Copy of the Birth Certificate of applicant who is supposedly
related to the child to be adopted.

28. Reason for the prospective adoptive parents’ (PAPs) choice of this/these particular child/children as their
adoptee/s.

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29. Attitude of prospective adoptive child/children towards his/her/their being adopted. (If applicable,
depending on age and level of maturity of prospective adoptive child/children).

30. Description of the degree of bonding between the prospective adoptive parents (PAPs) and the
prospective adoptive child/children. [To include, among others, ways and means of nurturing relationship
(letters, phone calls, greeting cards, etc), visits to the Philippines (who visited, when, duration of stay in the
Philippines, what they id together with the prospective adoptive child/children)]

31. Description of Living Accommodations (house or apartment; rented or owned) of applicants:

* Send at least one copy each of the following four poses:

1. Recently taken close-up picture of the PAPs
2. Recently taken close-up picture of the Child/Children, if possible with the PAPs during their visit to
the Philippines.
3. Home of prospective adoptive parents
4. Picture of significant adoptive parents
Ex: applicants’ family of origin, family of procreation, poses of relatives who are bound to touch the
life of the prospective adoptee/s

Date: ________________________ Signature: _____________________________________

Printed Name: _________________________________
Male Applicant

Date: ________________________ Signature: _____________________________________

Printed Name: __________________________________
Female Applicant

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 Information Required By The Inter Country Adoption Board in the Philippines

Full Name Husband:

Wife :

Birthdate Husband:
Wife :

Ethnic Origin Husband:

Wife :

Place of Birth Husband:

Wife :

Current Citizenship Husband:

Wife :

Degree of blood relationship to the child/children being sought for adoption:

Complete address of children in the Philippines:

Reason for the adoption plan:

Place of employment, position, length of employment:

Husband:

Wife :

Income Husband:
Wife :

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Description of living accommodations (house or apartment; rental or purchasing):

Names and birthdates of children currently in the home:

Other individuals who reside in the household (names; ages; relationship to applicants; permanent or
temporary resident of the household; contributions, if any, to family income):

____________________________ ______________________________
Date Signature

____________________________ ______________________________
Date Signature

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