REPUBLIC OF THE PHILIPPINES)

_______________ City) SS.

AFFIDAVIT
I, _________________, of legal age, single/married, and a resident of
______________________________ Philippines, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am the only legitimate child of spouses

________________________________ and ______________________________,
born on __________________ at __________________________, Philippines.
Machine copy of my Birth Certificate is hereto attached as ANNEX
“A”;

2. That We, _______________________, and ______________________________

are half-blood sisters/brothers on the Maternal/Paternal side;

3. That to the best of my knowledge we have no other known siblings

other than us;

4. That no other person rightfully entitled to claim our deceased

mother’s/father’s ______________________ benefits;

5. That I am executing this affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of

____________________ at _____________ City, Negros Occidental, Philippines.

_____________________________________

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

the City of _______________ this _____ day of ____________________. Affiant
personally came and appeared before me, bearing their photograph and
signature, known to me as the same persons who personally signed the
foregoing instrument before me and avowed under penalty of law to the whole
truth of the contents of said instrument.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019.