Republic of the Philippines )

___________________ ) S.S
x--------------------------------x

AFFIDAVIT OF KINSHIP

I, ___________________, of legal age, Filipino, and a resident of

_______________________, after having been duly sworn to in accordance
with the law, do hereby declare and state that:

1. I am the husband of the deceased __________________,

who died on _______________, in Southern Philippines Medical
Center (SPMC), Davao City;

2. I am making this affidavit in support of my request for the

release of the Death Certificate of my late wife
__________________, from the concerned government agency;
and

3. That I am executing this affidavit in good faith and to attest

to all the foregoing facts.

IN TRUTH WHEREOF, I have hereunto set my hand this 8 th day of

January 2023 in _________________, Philippines.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this 8th day of January

2023 in ______________________, Philippines.

Doc No. ____;

Page No. ____;
Book No. V;
Series of 2023.

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