REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION)
MUNICIPALITY OF AGOO)
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AFFIDAVIT OF KINSHIP

I, _________________, of legal age, Filipino, married, and a

resident of Barangay _____________________, after having been duly sworn
to in accordance with law, hereby depose and state that:

1. My parents are _________________. They were already deceased;

2. They had eight children namely, ______________________;

3. My brother, _________________ died on __________;

4. I am one of the nearest surviving heirs of my brother,

________________;

5. I am executing this affidavit for the purpose of securing copies of

the Certificate of Death and Certificate of Birth of my brother,
______________, before the Office of the Municipal Local Civil
Registrar of ___________________;

6. I am executing this affidavit to attest to the truth of the foregoing

facts and for all legal intents and purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ th day of

_____, in the Municipality of ________________, Philippines.

___________________________
Voter Certification VIN
______________________________

SUBSCRIBED AND SWORN TO before me this __ th day of _____, in the

Municipality of ________________, Philippines.