(Affidavit Attesting to the Death of a Person)

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

JOINT AFFIDAVIT

We, _____________ and _____________, both of legal ages, Filipinos, and residents of
_____________ and _____________, respectively, after having been duly sworn to in
accordance with law, do hereby depose and state the following:

1. That we are Barangay Officials of the aforementioned Barangay being the

_____________ and _____________, respectively.
2.
3. That we know the person of _____________ because he was a resident of the
aforementioned Barangay of which we are officials;
4.
5. That we know for a fact the said _____________ died on _____________ at
_____________ due to _____________;
6.
7. That we are executing this affidavit to attest to the truthfulness of the fact of death of
the person of _____________ and for whatever legal purposes that this statement may
serve.
8.
IN WITNESS WHEREOF, we have hereunto set our hands this _____________, in the
City of _____________, Philippines.

AFFIANT AFFIANT

(JURAT)