REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ILOCOS NORTE ) S.S

MUNICIPALITY OF SAN NICOLAS)

AFFIDAVIT OF KINSHIP

I, AB CD , Filipino of legal age, and a resident of Brgy, Philippines after having been duly sworn to in accordance with law,
do hereby depose and state:

That I am a legal heir and nearest kin of the late CG, who died on ____________________ and ____________________
respectively both at San Nicolas, Ilocos Norte, I being one of their grandson.

That I am executing this affidavit aware of my liabilities for falsehood if found otherwise to attest to the truth of all the
foregoing and for whatever legal intents and purposes it may serve.

In witness whereof, I have hereunto set my hand this ____ of __________ at San Nicolas, Ilocos Norte, Philippines.

AB CG
Affiant
PDL No. B02-82-002656

Subscribed and Sworn to before me this day of _______ of ____________ at San Nicolas, Ilocos Norte, Philippines. Affiant
exhibited to his LTO Driver’s License ID as a competent proof of identity.