REPUBLIC OF THE PHILIPPINES)

MALOLOS CITY, BULACAN )SS.

AFFIDAVIT OF KINSHIP

I, MYRA L. SUAREZ of legal age, Filipino citizen, a resident of No. 4750 Caimito
Street Old Santolan Gen. T. De Leon, Valenzuela City, after having been sworn to in accordance
with law hereby depose and say:

1. That I am the cousin of the late EDITHA SUAREZ URRUTIA, who died on April
02, 2021 at City of Valenzuela, Metro Manila as evidenced by her Certificate of Death;

2. That my above named deceased cousin died single without any son nor daughter of her
own;

3. That being the cousin and next of kin of the deceased EDITHA SUAREZ URRUTIA,
I am allowed to secure an PSA CENOMAR being required by the Government Service
Insurance System (GSIS) for the burial assistance and death claim of my late cousin;

4. That I am executing this affidavit to attest the truth of the foregoing facts that I am the
next of kin of the deceased EDITHA SUAREZ URRUTIA and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this day of _______________

at MALOLOS CITY, BULACAN

MYRA L. SUAREZ
Affiant

SUBSCRIBED AND SWORN to before me this day of ___________ at MALOLOS

CITY, BULACAN

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2021