CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES

DUBAI, UNITED ARAB EMIRATES

AUTHORIZATION FORM
Date: __________________

I/We, the undersigned, hereby authorize Mr./Ms. _________________________________ to process the

(Name of Authorized Representative)
Report of Death and the No Objection Certificate of _____________________________________ who is
(Name of deceased OF)
my _____________________, as I/we cannot personally appear before the you because of personal
(relationship)
reason/s.

This is also to certify that I/we, the next-of-kin of the deceased OF, personally accomplished and provided
the details required below to facilitate the processing of necessary documents from the Consulate General.

Attached is my/our identification cards. Thank you very much for your understanding and kind assistance.

Respectfully yours,
Name & Signature: ___________________________________
Date:______________________________________________

PARTICULARS OF THE DECEASED

Name:_____________________________________
Date of Death:_________________ Cause of Death:____________________________________________
Address in UAE:____________________________________________________________
Passport no.: __________________ Date of Issue/Valid Until: ________________________
Disposition of Remains (Please mark with an “X”):
____ Repatriate to the Philippines
____ Cremation / Ashes repatriated to the Philippines
____ Buried in UAE Emirate: ___________________________
Final destination of the Remains/Cremains if they are to be shipped to the Philippines:
_____________________________________________________________________

Name of Employer/Sponsor: ________________________ Contact No.: ______________________

Address: ________________________________________________________________________

PARTICULARS OF THE NEXT-OF-KIN

Name:___________________________________ Contact Number:________________________
Address in Philippines/UAE:___________________________________________________
Valid Passport or ID / Number:______________________________________
Relationship to the Deceased:
___ Wife/Husband ___ Parent/s
___ Child (Legal age) ___ Sibling/s
Others: ________________________ If the legal Next-of-Kin is not available, explain the details(ex: spouse is
separated, etc.):

PARTICULARS OF THE AUTHORIZED PERSON / INFORMANT

Name: ___________________________________ Contact No.: _________________________________
Address in UAE: _________________________________________________
Relationship to the Deceased: _________________________________________________
Relationship to the Next-of-Kin: _______________________________________________