(Affidavit Attesting to the Death of a Person)
This declaration that a person has died, is a requirement for insurance, SSS, PagIbig and PhilHealth claims.
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 _____________ at _____________ 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.