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Affidavit Attesting to the Death of a Person

Republic of the Philippines)

Province of _____________)S.S.

City/Municipality of _________)


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

SUBSCRIBED AND SWORN to before me this _______________ at _______________, Affiant exhibiting to me her _________________  issued on _________ and expiring on ________. 

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