REPUBLIC OF THE PHILIPPINES)

Province of ____________________ ) S.S.

City/Municipality of _____________ ) x - - - - - - - - - - - - - - - - - - - - -x

JOINT AFFIDAVIT

We, _____________ and _____________ , both of legal ages, Filipinos, and

residents of _____________ and _____________ , respectively, after having been duly
sworn to in accordance with law, do hereby depose and state the following:

That we are Barangay Officials of the aforementioned Barangay being the _____________

and _____________ , respectively

That we know the person of _____________ because he was a resident of the

aforementioned Barangay of which we are officials;

That we know for a fact the said _____________ died on _____________

_____________due to _____________

That we are executing this affidavit to attest to the truthfulness of the fact of
death of the person of _____________ and for whatever legal purposes that this statement
may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ , in

the City of _____________ , Philippines.

AFFIANT AFFIANT