SAMPLE AFFIDAVIT | ATTESTING TO THE DEATH OF A PERSON

REPUBLIC OF THE PHILIPPINES)

Quezon City, Philippines                       ) S.S.

AFFIDAVIT

I, Maria Ligaya, Filipino, of legal age, and a resident of 123 Bagong Liwanag, Barangay Sinilangan, Quezon City, Philippines, having been duly sworn in accordance with law, hereby depose and state:

1. That I am a Barangay Chairman of the above-mentioned Barangay;

2. That I know the person of Mary Anne because she was a resident of the above-mentioned Barangay of which I am an Official;

3. That I know for a fact that said Mary Anne died on February 27, 2022 at Farmers Plaza, Araneta Center, Cubao Quezon City due to Cardiac arrest; and

4. That I am executing this affidavit to attest to the truthfulness of the facts of death of the person of Mary Anne and for whatever legal purposes that this statement may serve.

IN WITNESS WHEREOF, I hereby set my hand this 28th day of February 2022, in the City of Quezon, Metro Manila, Philippines.

MARIA LIGAYA

Affiant

JURAT

(Please see sample my sample format of Jurat on this link: Sample Jurat)