Republic of the Philippines)

_________________ City ) S.S.

JOINT AFFIDAVIT
OF TWO DISINTERESTED PERSONS

We, ____________________ and ____________________, Filipinos, both

of legal age, with respective addresses at _______________________ and
________________________, after having been duly sworn to in accordance with
law, depose and say that:

1. We know personally _____________________, Filipino, of legal age, with

address at ________________________ and we likewise know for a fact
that he was admitted to and confined at the ________________________
last ____________, however he died on _____________.

2. We noticed that there is an error his ______________ Record wherein what

was indicated as his name is ______________ instead of ____________.

3. We attest to the fact that __________________ appearing in the

________________ Record and __________________ stated in his
______________________ Record refer to one and the same person.

4. We are executing this affidavit to attest to the truth of the foregoing facts.

Affiants further sayeth naught.

IN WITNESS HEREOF, we have hereunto set our hands this __ th day of

October 2021 in Quezon City.

__________________ ____________________
Affiant Affiant
Driver’s License No. Driver’s License No.

SUBSCRIBED AND SWORN to before me this __h day of October 2021,

affiants presented to be their government issued ID as indicated below their names.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2021.