Republic of the Philippines )

City of _____________ ) S.S.

AFFIDAVIT OF NEXT OF KIN

I, (NAME OF AFFIANT), Filipino, of legal age, single/married, and a residents of
(Address of Affiant), after having been sworn to in accordance with law, hereby depose and
state:

1. That I am the next of kin, being the sister, of the late (NAME OF DECEDENT), who
died intestate on (Date of Death) at (Place of Death);

2. That the decedent died single, thus left no surviving spouse nor children;

3. That no personal representative has been appointed for the decedent’s estate or
elsewhere and no application for such appointment is pending;

4. That this affidavit is made in support of the undersigned’s application for Registration
of Death of the late (Name of Decedent), as available next of kin, from the Civil
Registrar.

IN WITNESS WHEREOF, I have hereunto affixed our signature this (Date of

Notarization), in (Place of Notarization).

(NAME OF AFFIANT)
Affiant

SUBSCRIBED AND SWORN to before me this (Date of Notarization) in (Place of

Notarization), with affiant exhibiting to me (ID Details).

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of _____.