REPUBLIC OF THE PHILIPPINES)

City of Tacloban ) S.S.

AFFIDAVIT OF KINSHIP

I, _______________________, Filipino, of legal, married and a resident of

_________________________, Leyte, after having been duly sworn in accordance
with law, hereby depose and state: THAT-

1. I am the legitimate sister of ______________________, who died last

___________________ in Tacloban City, Philippines;

2. We were born to the spouses ______________ and

_________________who died on __________________and
_________________, respectively. A copy of my Baptismal
Certificate is hereto attached as Annex “A”;

3. I am executing this affidavit for the purpose of securing the Death

Certificate of my late brother, ____________________ from the
Philippine Statistics Authority (PSA) and to declare the truth of the
foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________________ at Tacloban City, Philippines.

___________________________________
Affiant

SUBSCRIBED AND SWORN to before me, this _______________________

at Tacloban City by the affiant who exhibited to me her __________________ with
No. _____________________, known to me to be the same person who executed
the foregoing affidavit.

Doc. No. ______;

Page No.______;
Book No. _____;
Series of 2019.