Affidavit Attesting to the Death of a Person

Republic of the Philippines)

Province of _____________)S.S.
City/Municipality of _________)

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:

That we are Barangay Officials of the aforementioned Barangay being the

_____________ and _____________, respectively.

That we know the person of _____________ because he was a resident of the

aforementioned Barangay of which we are officials;

That we know for a fact the said _____________ died on _____________ at

_____________ due to _____________;

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.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________,

in the City of _____________, Philippines.

Affiant Affiant